Provider Demographics
NPI:1013513274
Name:SUMMERVILLE, CARTER WHEELER
Entity type:Individual
Prefix:
First Name:CARTER
Middle Name:WHEELER
Last Name:SUMMERVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 FENTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1858
Mailing Address - Country:US
Mailing Address - Phone:757-844-7192
Mailing Address - Fax:
Practice Address - Street 1:7505 RICHMOND RD STE 3300-304
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7226
Practice Address - Country:US
Practice Address - Phone:757-844-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional