Provider Demographics
NPI:1356466163
Name:SIMPSON, DAPHNE (ALC)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-3047
Mailing Address - Country:US
Mailing Address - Phone:256-546-9265
Mailing Address - Fax:256-549-0376
Practice Address - Street 1:701 GAULT AVENUE
Practice Address - Street 2:STE. B
Practice Address - City:FT. PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-2627
Practice Address - Country:US
Practice Address - Phone:256-845-8227
Practice Address - Fax:256-845-8226
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1302A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC1302AOtherLICENSE
ALI882Medicare PIN