MEDICARE: MRS. DESMIAH SIMMONS LAPC, NCC

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	APC008971	GA
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1821861196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DESMIAH SIMMONS LAPC, NCC

Provider Business Mailing Address
First Line	:	6221 LONG SHORE DR
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-5921
Country	:	US
Telephone Number	:	706-469-7028
Fax Number	:

Provider Business Practice Location Address
First Line	:	6221 LONG SHORE DR
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-5921
Country	:	US
Telephone Number	:	706-469-7028
Fax Number	:

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

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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