Provider Demographics
NPI:1255473690
Name:LIVINGSTON, SUMMERLYN ROBIN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUMMERLYN
Middle Name:ROBIN
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUMMERLYN
Other - Middle Name:ROBIN
Other - Last Name:DAVISSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-3605
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-9927221041C0700X
TX532041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX53204OtherTEXAS STATE BOARD OF SOCIAL WORK EXAMINUERS
COCSW-992722OtherLCSW