MEDICARE: MONIQUE SIMS LPC

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	LPC011097	GA
2	101Y00000X	Counselor	6401014552	MI

General Provider Information

NPI Number	:	1346601499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE SIMS LPC

Provider Business Mailing Address
First Line	:	1720 MARS HILL RD NW STE 8-154
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-7127
Country	:	US
Telephone Number	:	313-515-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 MARS HILL RD NW STE 8-154
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-7127
Country	:	US
Telephone Number	:	470-377-2286
Fax Number	:

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

Provider Enumeration Date	:	03/17/2016
Last Update Date	:	02/16/2021

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