Provider Demographics
NPI:1306393285
Name:SIMON, DOMINIC (LMSW)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-0644
Mailing Address - Country:US
Mailing Address - Phone:864-451-2258
Mailing Address - Fax:888-817-0606
Practice Address - Street 1:610 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-5035
Practice Address - Country:US
Practice Address - Phone:803-225-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC158541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical