Provider Demographics
NPI:1669864013
Name:SUMERS, MOLLY (LADC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SUMERS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502-1011
Mailing Address - Country:US
Mailing Address - Phone:218-847-1329
Mailing Address - Fax:218-847-1398
Practice Address - Street 1:28579 US HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-7308
Practice Address - Country:US
Practice Address - Phone:218-847-1329
Practice Address - Fax:218-847-1398
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304112101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)