Provider Demographics
NPI:1932439452
Name:SUMNER, TAD (LCSW, CDCI)
Entity Type:Individual
Prefix:
First Name:TAD
Middle Name:
Last Name:SUMNER
Suffix:
Gender:M
Credentials:LCSW, CDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E TUDOR RD
Mailing Address - Street 2:STE 135
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7457
Mailing Address - Country:US
Mailing Address - Phone:907-644-8044
Mailing Address - Fax:907-644-8004
Practice Address - Street 1:701 E TUDOR RD
Practice Address - Street 2:STE 135
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7457
Practice Address - Country:US
Practice Address - Phone:907-644-8044
Practice Address - Fax:907-644-8004
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
AK10421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health