Healthcare Provider Details

I. General information

NPI: 1104635358
Provider Name (Legal Business Name): LESLEY BLAIR SIMMONS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW STE 602
WASHINGTON DC
20036-1716
US

IV. Provider business mailing address

1350 CONNECTICUT AVE NW STE 602
WASHINGTON DC
20036-1716
US

V. Phone/Fax

Practice location:
  • Phone: 202-992-8353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: