Healthcare Provider Details

I. General information

NPI: 1295640050
Provider Name (Legal Business Name): TIMIA STAGG-SIMMONS LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 BRIGHTSEAT RD
LANDOVER MD
20785-4725
US

IV. Provider business mailing address

712 KAPLAN CT
HYATTSVILLE MD
20785-4625
US

V. Phone/Fax

Practice location:
  • Phone: 301-333-2980
  • Fax:
Mailing address:
  • Phone: 202-660-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP18341
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: