MEDICARE: SIMONE GARDNER HSCI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1174669923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONE GARDNER HSCI

Provider Business Mailing Address
First Line	:	4033 VILLAGE PARK DR STE 123
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7044
Country	:	US
Telephone Number	:	704-451-8476
Fax Number	:	888-314-2903

Provider Business Practice Location Address
First Line	:	4033 VILLAGE PARK DR # 123
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7044
Country	:	US
Telephone Number	:	704-451-8476
Fax Number	:	888-314-2903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	10/03/2024

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