Provider Demographics
NPI:1114737244
Name:BETTY DEBERRY-SUMNER, LLC
Entity type:Organization
Organization Name:BETTY DEBERRY-SUMNER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEBERRY-SUMNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, LCPC
Authorized Official - Phone:240-506-4040
Mailing Address - Street 1:10410 KENSINGTON PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2947
Mailing Address - Country:US
Mailing Address - Phone:240-506-4040
Mailing Address - Fax:240-559-0921
Practice Address - Street 1:10410 KENSINGTON PKWY STE 203
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2947
Practice Address - Country:US
Practice Address - Phone:240-506-4040
Practice Address - Fax:240-559-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty