Provider Demographics
NPI:1457814246
Name:SUMMIT COUNSELING SERVICES. LLC
Entity Type:Organization
Organization Name:SUMMIT COUNSELING SERVICES. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELINOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSHINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-441-8095
Mailing Address - Street 1:8834 COTTONGRASS ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4943
Mailing Address - Country:US
Mailing Address - Phone:240-441-8095
Mailing Address - Fax:301-710-0175
Practice Address - Street 1:2671 MATTAWOMAN BEANTOWN RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2340
Practice Address - Country:US
Practice Address - Phone:240-441-8095
Practice Address - Fax:301-710-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265401OtherJOHNS HOPKINS US FAMILY HEALTH PLAN