Provider Demographics
NPI:1245249358
Name:SUMMERLIN, JULIA REDDITT (RN, MSN, CS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:REDDITT
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:RN, MSN, CS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S GREENO RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2069
Mailing Address - Country:US
Mailing Address - Phone:251-928-1658
Mailing Address - Fax:251-928-1371
Practice Address - Street 1:50 SOUTH GREENO RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36533-0414
Practice Address - Country:US
Practice Address - Phone:251-928-1658
Practice Address - Fax:251-928-1371
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL219106H00000X
AL1-027218163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL63-0977984OtherEIN