MEDICARE: PORTIA SIMMONS

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	171400000X	Health & Wellness Coach	COU.10506	SC
2	171M00000X	Case Manager/Care Coordinator
3	101YM0800X	Mental Health Counselor	COU.10506	SC

General Provider Information

NPI Number	:	1871051425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORTIA SIMMONS

Provider Business Mailing Address
First Line	:	17 BAINBRIDGE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4240
Country	:	US
Telephone Number	:	843-709-7356
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 BAINBRIDGE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4240
Country	:	US
Telephone Number	:	843-709-7356
Fax Number	:

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

Provider Enumeration Date	:	03/03/2019
Last Update Date	:	12/02/2025

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Directions to “ PORTIA SIMMONS ” Practice Location

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