Healthcare Provider Details

I. General information

NPI: 1619414349
Provider Name (Legal Business Name): JULIE SIMMONS LCMHC,LCAS,CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N KERR AVE STE C2
WILMINGTON NC
28405-3439
US

IV. Provider business mailing address

3953B MARKET ST
WILMINGTON NC
28403-1403
US

V. Phone/Fax

Practice location:
  • Phone: 910-540-6749
  • Fax: 910-769-1772
Mailing address:
  • Phone: 910-540-6749
  • Fax: 910-769-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number13093
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21056
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13093
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13093
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: