=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790855963
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA D SIMS M.ED., L.P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 02/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3455 LAWRENCEVILLE SUWANEE RD SUITE D
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-6425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-496-5041
-----------------------------------------------------
Fax | 404-424-9383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 722 COLLINS HILL RD SUITE H-311
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046-4118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-496-5041
-----------------------------------------------------
Fax | 404-424-9383
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC000790
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------