Provider Demographics
NPI:1093322125
Name:SIMS, SHANNARESE (LGPC)
Entity Type:Individual
Prefix:
First Name:SHANNARESE
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 FRANKLIN ST NE APT 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2041
Mailing Address - Country:US
Mailing Address - Phone:216-225-7230
Mailing Address - Fax:
Practice Address - Street 1:1615 FRANKLIN ST NE APT 305
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2041
Practice Address - Country:US
Practice Address - Phone:216-225-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00695101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor