Provider Demographics
NPI:1760616213
Name:SUMMERS, JODY STEVENSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:STEVENSON
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 BENTLEY DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7500
Mailing Address - Country:US
Mailing Address - Phone:803-606-6678
Mailing Address - Fax:
Practice Address - Street 1:704 BENTLEY DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7500
Practice Address - Country:US
Practice Address - Phone:803-606-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical