Provider Demographics
NPI:1083992895
Name:SIMON, GINA A (LPCMH)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:A
Last Name:SIMON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W. LOOKERMAN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901
Mailing Address - Country:US
Mailing Address - Phone:302-674-1397
Mailing Address - Fax:302-674-1602
Practice Address - Street 1:121 W LOOCKERMAN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7325
Practice Address - Country:US
Practice Address - Phone:302-674-1397
Practice Address - Fax:302-674-1602
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000552101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor