Provider Demographics
NPI:1669252680
Name:SOMMER, LYDIA MICHL (P018308)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MICHL
Last Name:SOMMER
Suffix:
Gender:F
Credentials:P018308
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N 3RD ST STE 401
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3474
Mailing Address - Country:US
Mailing Address - Phone:910-769-9126
Mailing Address - Fax:910-769-9169
Practice Address - Street 1:5320 BRIDGERS RD STE 2
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4737
Practice Address - Country:US
Practice Address - Phone:910-769-9126
Practice Address - Fax:910-769-9169
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0183081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty