Provider Demographics
NPI:1164535654
Name:SIMMONS, TAQUISA KATINA (LCSW, CSAC)
Entity Type:Individual
Prefix:
First Name:TAQUISA
Middle Name:KATINA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 BRISA CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7155
Mailing Address - Country:US
Mailing Address - Phone:757-404-1900
Mailing Address - Fax:
Practice Address - Street 1:212 RESEARCH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5984
Practice Address - Country:US
Practice Address - Phone:757-673-8117
Practice Address - Fax:757-673-8127
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710101902101YA0400X
VA09040062641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical