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General NPI Number Information
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NPI Number | 1548754922
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Entity Type | Individual
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Provider Name | ALEXANDER SIMMONS LMSW-C
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Gender | Male
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 6548 TOWN CENTER DR STE D
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City | CLARKSTON
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State | MI
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Zip | 48346-4823
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Country | US
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Telephone | 248-483-0507
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Fax |
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Provider Business Mailing Address
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Address Line | 12421 FIRST AVE S
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City | SOUTHGATE
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State | MI
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Zip | 48195-3541
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851107036
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801107036
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801115584
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License Number State | MI
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