Provider Demographics
NPI:1164643904
Name:SIMMONS, MARCIA MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15165 CHARTER OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-1143
Mailing Address - Country:US
Mailing Address - Phone:831-633-4384
Mailing Address - Fax:
Practice Address - Street 1:154 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2657
Practice Address - Country:US
Practice Address - Phone:831-633-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist