Provider Demographics
NPI:1679132633
Name:SUMMERS, TIFFANY NAKIKA (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NAKIKA
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 TIMBER DR E # 1021
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6917
Mailing Address - Country:US
Mailing Address - Phone:252-432-0948
Mailing Address - Fax:
Practice Address - Street 1:123 PRONGHORN DEER CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7186
Practice Address - Country:US
Practice Address - Phone:919-525-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0141741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical