Mary Ann Summerlin, LPCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11015 Issued in NC

Practice address

201 New Bridge St
Suite 105
Jacksonville, NC 28540-4736

Phone

(910) 336-4958

Fax

(910) 333-9742

NPI assigned

Jul 29, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1487062824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 NEW BRIDGE ST",
            "address_2": "SUITE 105",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285404736",
            "telephone_number": "910-336-4958",
            "fax_number": "910-333-9742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 NEW BRIDGE ST",
            "address_2": "SUITE 105",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285404736",
            "telephone_number": "910-336-4958",
            "fax_number": "910-333-9742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERLIN",
        "first_name": "MARY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LPCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-29",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS - 21026",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "11015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracey Suggs, LCAS, LPCA
• Ericka Lee Sullivan-Gamble, LCSW-A
• Brianna Hohman Sullivan, DPT
• Kimberly Jarman Sullivan, R.PH.
• Bridget Sultzer
• Nicole Summerlin, PTA
• Suncoast Medical, PC
• Tyra Sundquist, RN
• Katherine Price Sutherland, FNP-C
• Justin Sutton Sutton, IDC

• Mental Health Counselor in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.