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General NPI Number Information
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NPI Number | 1366090888
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Entity Type | Organization
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Legal Business Name | SIMON-FIELDS COUNSELING & CONSULTATION
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 4011 BEATLINE RD STE 9
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City | LONG BEACH
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State | MS
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Zip | 39560-4135
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Country | US
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Telephone | 228-332-0224
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Fax |
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Provider Business Mailing Address
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Address Line | 4 HARTFORD PL
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City | GULFPORT
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State | MS
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Zip | 39507-2241
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Country | US
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Telephone | 228-332-0224
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Fax |
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | ANGELA SIMON FIELDS
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Credential | LCSW
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Telephone | 228-332-0224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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