Provider Demographics
NPI:1235571548
Name:SIMMONS, VELDA (LCASA)
Entity Type:Individual
Prefix:
First Name:VELDA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MCCULLOUGH DR STE 456
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3310
Mailing Address - Country:US
Mailing Address - Phone:704-258-6366
Mailing Address - Fax:704-663-5053
Practice Address - Street 1:10820 TRADITION VIEW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1421
Practice Address - Country:US
Practice Address - Phone:704-258-6366
Practice Address - Fax:704-663-5053
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1111101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1111OtherNC DHSR