Individual provider Active NPI

Michaela Monique Summers, ED.S., LPC

  • Mental Health Counselor
  • Conyers, GA
National Provider Identifier
1528956646
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LPC015758 Issued in GA
Practice address
247 Centennial Ridge Dr
Conyers, GA 30013-1518
Phone
(678) 739-9140
NPI assigned
Jun 26, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LPC015758 GA Primary

Addresses

Primary practice location

247 Centennial Ridge Dr
Conyers, GA 30013-1518

Mailing address

247 Centennial Ridge Dr
Conyers, GA 30013-1518
Phone (678) 739-9140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LPC015758GAMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1750896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1528956646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 CENTENNIAL RIDGE DR",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131518",
            "telephone_number": "678-739-9140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 CENTENNIAL RIDGE DR",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131518",
            "telephone_number": "678-739-9140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERS",
        "first_name": "MICHAELA",
        "middle_name": "MONIQUE",
        "name_prefix": "Ms.",
        "credential": "ED.S., LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-06-26",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC015758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.