Provider Demographics
NPI:1821645128
Name:SUMMERS, TINA FAYE (LICSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:FAYE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17046 N HAGLER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-5024
Mailing Address - Country:US
Mailing Address - Phone:205-292-8278
Mailing Address - Fax:
Practice Address - Street 1:17046 N HAGLER RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-5024
Practice Address - Country:US
Practice Address - Phone:207-292-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2343C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical