Provider Demographics
NPI:1326524778
Name:SIMMONS-ABUEL, CHARNETTA LAVIA
Entity Type:Individual
Prefix:
First Name:CHARNETTA
Middle Name:LAVIA
Last Name:SIMMONS-ABUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24302 DELTA DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4306
Mailing Address - Country:US
Mailing Address - Phone:909-973-4575
Mailing Address - Fax:
Practice Address - Street 1:24302 DELTA DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4306
Practice Address - Country:US
Practice Address - Phone:909-973-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)