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: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 CARPENTER DR STE 400
SANDY SPRINGS GA
30328-4933
US

IV. Provider business mailing address

PO BOX 1719
PINE LAKE GA
30072-1719
US

V. Phone/Fax

Practice location:
  • Phone: 678-460-0345
  • Fax: 678-460-0350
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: