Healthcare Provider Details

I. General information

NPI: 1043171622
Provider Name (Legal Business Name): JOSEPH ANDREW SIMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 MARS HILL RD STE A
WATKINSVILLE GA
30677-4893
US

IV. Provider business mailing address

171 OSCEOLA AVE
BOGART GA
30622-1506
US

V. Phone/Fax

Practice location:
  • Phone: 706-310-9046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: