Provider Demographics
NPI:1245905892
Name:SUMMERS, JOELLE (LLMSW)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37202 S WOODBRIDGE CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7249
Mailing Address - Country:US
Mailing Address - Phone:810-965-8923
Mailing Address - Fax:
Practice Address - Street 1:2387 S LINDEN RD STE 104
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5487
Practice Address - Country:US
Practice Address - Phone:810-230-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
MI68011099531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty