Provider Demographics
NPI:1477803401
Name:HALL-SUMMERS, GENICE (LISW-CP)
Entity Type:Individual
Prefix:
First Name:GENICE
Middle Name:
Last Name:HALL-SUMMERS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 JOHNNY LORICK CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8955
Mailing Address - Country:US
Mailing Address - Phone:803-673-8459
Mailing Address - Fax:
Practice Address - Street 1:3 JOHNNY LORICK CT
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8955
Practice Address - Country:US
Practice Address - Phone:803-673-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0066001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical