Provider Demographics
NPI:1275837056
Name:SIMMONS, WILLIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 SPRING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2924
Mailing Address - Country:US
Mailing Address - Phone:240-432-9887
Mailing Address - Fax:
Practice Address - Street 1:107 PARK PL
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4513
Practice Address - Country:US
Practice Address - Phone:703-538-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical