Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 10896 | NC |
N | 101YP2500X | Professional Counselor | 10896 | NC |
NPI | 1003216995 |
---|---|
Provider Name | Jeffrey Alan Simms |
First Address | Thomasville, NC 27360-9720 |
Second Address | Winston Salem, NC 27106-3296 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2014 |
Last Update Date | 08/07/2019 |