=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548999113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY SHAKIRIE SIMMONS MSW, LISW-CP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2022
-----------------------------------------------------
Last Update Date | 05/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 430 WOODRUFF RD STE 450
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29607-3443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-400-5130
-----------------------------------------------------
Fax | 864-818-4697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 365 HAMILTON PKWY
-----------------------------------------------------
City | EASLEY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29642-3039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-506-3202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 14439
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 16679
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------