Healthcare Provider Details

I. General information

NPI: 1134501372
Provider Name (Legal Business Name): SHARALYNN SIMMONS MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HOMESTEAD DR
DALLAS GA
30157-4662
US

IV. Provider business mailing address

605 HOMESTEAD DR
DALLAS GA
30157-4662
US

V. Phone/Fax

Practice location:
  • Phone: 248-229-1930
  • Fax:
Mailing address:
  • Phone: 248-229-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number014310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: