Provider Demographics
NPI:1780955161
Name:STEFANIE SUMMERS, LTD
Entity type:Organization
Organization Name:STEFANIE SUMMERS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-841-2291
Mailing Address - Street 1:10421 VFW ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8032
Mailing Address - Country:US
Mailing Address - Phone:907-841-2291
Mailing Address - Fax:907-694-2291
Practice Address - Street 1:10421 VFW ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8032
Practice Address - Country:US
Practice Address - Phone:907-841-2291
Practice Address - Fax:907-694-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty