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General NPI Number Information
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NPI Number | 1922155647
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Entity Type | Individual
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Provider Name | SALEEB SIMON LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 175 GWINNETT DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-8444
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Country | US
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Telephone | 770-339-5107
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Fax | 770-822-1698
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Provider Business Mailing Address
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Address Line | 4591 MONTAUK RD SW
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City | LILBURN
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State | GA
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Zip | 30047-3934
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Country | US
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Telephone | 770-339-5107
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Fax | 770-822-1698
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 001977
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License Number State | GA
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