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General NPI Number Information
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NPI Number | 1457780843
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Entity Type | Individual
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Provider Name | KIMBERLY O SIMMONS LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 1505 BRIDFORD PKWY APT 5B
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City | GREENSBORO
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State | NC
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Zip | 27407-2675
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Country | US
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Telephone | 301-256-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 BRIDFORD PKWY APT 5B
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City | GREENSBORO
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State | NC
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Zip | 27407-2675
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Country | US
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Telephone | 301-256-8280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | LC50079155
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LC50079155
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50079155
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License Number State | DC
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