Provider Demographics
NPI:1073957858
Name:SIMMONS, VONDALYN W (MA)
Entity Type:Individual
Prefix:
First Name:VONDALYN
Middle Name:W
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 DUKE ST
Mailing Address - Street 2:P. O. BOX 311
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-4403
Mailing Address - Country:US
Mailing Address - Phone:843-255-6007
Mailing Address - Fax:
Practice Address - Street 1:1905 DUKE ST
Practice Address - Street 2:SUITE 270
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-4403
Practice Address - Country:US
Practice Address - Phone:843-255-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)