Healthcare Provider Details

I. General information

NPI: 1033033824
Provider Name (Legal Business Name): SHANNON DEMETRIA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 WILLIAMS DR
MURFREESBORO TN
37129-3194
US

IV. Provider business mailing address

3012 WEEPING WILLOW LN
THOMPSONS STATION TN
37179-1006
US

V. Phone/Fax

Practice location:
  • Phone: 615-914-8138
  • Fax:
Mailing address:
  • Phone: 615-914-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: