Healthcare Provider Details

I. General information

NPI: 1265372122
Provider Name (Legal Business Name): LEAH SIMONSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ARGONNE DR
BALTIMORE MD
21218-1943
US

IV. Provider business mailing address

314 S MADEIRA ST
BALTIMORE MD
21231-2743
US

V. Phone/Fax

Practice location:
  • Phone: 410-889-5054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: