Provider Demographics
NPI:1528836335
Name:DANIELS, SUMMER ELISE (RMHC INTERN)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:ELISE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:RMHC INTERN
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:ELISE
Other - Last Name:KRLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 S WICKHAM RD STE 107
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1429
Mailing Address - Country:US
Mailing Address - Phone:321-608-0604
Mailing Address - Fax:
Practice Address - Street 1:630 S WICKHAM RD STE 107
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1429
Practice Address - Country:US
Practice Address - Phone:321-608-0604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health