Healthcare Provider Details

I. General information

NPI: 1366090888
Provider Name (Legal Business Name): SIMON-FIELDS COUNSELING & CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 BEATLINE RD STE 9
LONG BEACH MS
39560-4135
US

IV. Provider business mailing address

4 HARTFORD PL
GULFPORT MS
39507-2241
US

V. Phone/Fax

Practice location:
  • Phone: 228-332-0224
  • Fax:
Mailing address:
  • Phone: 228-332-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANGELA SIMON FIELDS
Title or Position: OWNER/ PROVIDER
Credential: LCSW
Phone: 228-332-0224