Healthcare Provider Details

I. General information

NPI: 1023143591
Provider Name (Legal Business Name): CORRINE SIMONS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 S CAPITOL ST SW
WASHINGTON DC
20032-2107
US

IV. Provider business mailing address

PO BOX 6716
WASHINGTON DC
20020-0416
US

V. Phone/Fax

Practice location:
  • Phone: 202-373-1815
  • Fax: 202-562-0576
Mailing address:
  • Phone: 202-302-8609
  • Fax: 202-562-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAB23135
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: