Provider Demographics
NPI:1215564851
Name:SIMMONS, LAURIE HALSEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:HALSEY
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:JEAN
Other - Last Name:HALSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0629
Mailing Address - Country:US
Mailing Address - Phone:252-482-6347
Mailing Address - Fax:252-482-6381
Practice Address - Street 1:211 VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9668
Practice Address - Country:US
Practice Address - Phone:252-482-6347
Practice Address - Fax:252-482-6381
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0035731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical