Healthcare Provider Details

I. General information

NPI: 1285385070
Provider Name (Legal Business Name): QIANA PENDORIN SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 HEMBY LN
GREENVILLE NC
27834-3775
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-4500
  • Fax: 252-744-5713
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018805
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: