Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | LA |
NPI | 1114393014 |
---|---|
Provider Name | Andrea Simmons |
First Address | Baton Rouge, LA 70816-1846 |
Second Address | Baton Rouge, LA 70816-1846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2015 |
Last Update Date | 13/08/2015 |