Healthcare Provider Details

I. General information

NPI: 1083519326
Provider Name (Legal Business Name): KATHLEEN MARIE SIMPSON LCAS, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N MAIN ST
REIDSVILLE NC
27320-2902
US

IV. Provider business mailing address

PO BOX 1121
REIDSVILLE NC
27323-1121
US

V. Phone/Fax

Practice location:
  • Phone: 336-280-0371
  • Fax: 336-342-9506
Mailing address:
  • Phone: 336-280-0371
  • Fax: 336-342-9506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-21241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: