Provider Demographics
NPI:1871382176
Name:SUMMERS, MARK CHARLES (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:SUMMERS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3043
Mailing Address - Country:US
Mailing Address - Phone:541-619-9579
Mailing Address - Fax:
Practice Address - Street 1:925 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3043
Practice Address - Country:US
Practice Address - Phone:541-619-9579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL13581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical