MEDICARE: DUSTIN NEAL SIMON LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10573	SC

General Provider Information

NPI Number	:	1669357869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN NEAL SIMON LPCA

Provider Business Mailing Address
First Line	:	246 ROCKMONT DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6477
Country	:	US
Telephone Number	:	803-619-9055
Fax Number	:	803-845-3738

Provider Business Practice Location Address
First Line	:	246 ROCKMONT DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6477
Country	:	US
Telephone Number	:	803-619-9055
Fax Number	:	803-845-3738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/07/2025

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