Healthcare Provider Details

I. General information

NPI: 1972063600
Provider Name (Legal Business Name): DANA ELIZABETH SIMONS LCAC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 WASHINGTON AVE
TERRE HAUTE IN
47802-1128
US

IV. Provider business mailing address

619 WASHINGTON AVE
TERRE HAUTE IN
47802-1128
US

V. Phone/Fax

Practice location:
  • Phone: 812-917-5006
  • Fax:
Mailing address:
  • Phone: 812-917-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001599A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33008381A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: