MEDICARE: DAPHNE SIMPSON ALC

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	101YP2500X	Professional Counselor	C1302A	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C1302A	OTHER	AL	LICENSE

General Provider Information

NPI Number	:	1356466163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAPHNE SIMPSON ALC

Provider Business Mailing Address
First Line	:	3001 SCENIC HWY
Second Line	:
City	:	GADSDEN
State	:	AL
Zip	:	35904-3047
Country	:	US
Telephone Number	:	256-546-9265
Fax Number	:	256-549-0376

Provider Business Practice Location Address
First Line	:	701 GAULT AVENUE
Second Line	:	STE. B
City	:	FT. PAYNE
State	:	AL
Zip	:	35967-2627
Country	:	US
Telephone Number	:	256-845-8227
Fax Number	:	256-845-8226

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	03/13/2008

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