Provider Demographics
NPI:1548766231
Name:JESSICA F SUMMERS LCSW LLC
Entity Type:Organization
Organization Name:JESSICA F SUMMERS LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-466-6895
Mailing Address - Street 1:2356 SCHENLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3318
Mailing Address - Country:US
Mailing Address - Phone:434-466-6895
Mailing Address - Fax:
Practice Address - Street 1:9327 MIDLOTHIAN TPKE STE 2G
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4944
Practice Address - Country:US
Practice Address - Phone:804-277-9034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904007055OtherSTATE LICENSE BOARD OF HEALTH PROFESSIONS