Provider Demographics
NPI:1790459196
Name:DAVIES OLDHAM, SUMMER (RBT)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:DAVIES OLDHAM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:LEIGH
Other - Last Name:BULLECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:26 CHURCHHILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:AL
Mailing Address - Zip Code:36856-5613
Mailing Address - Country:US
Mailing Address - Phone:706-505-4272
Mailing Address - Fax:
Practice Address - Street 1:5900 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4362
Practice Address - Country:US
Practice Address - Phone:850-670-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician