Provider Demographics
NPI:1376999789
Name:SIMMONS, CHERRY GRANT (PHD IN COUNSELING)
Entity Type:Individual
Prefix:DR
First Name:CHERRY
Middle Name:GRANT
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PHD IN COUNSELING
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 22
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-0022
Mailing Address - Country:US
Mailing Address - Phone:912-559-2636
Mailing Address - Fax:
Practice Address - Street 1:420 CEDAR ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31546-3520
Practice Address - Country:US
Practice Address - Phone:912-559-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03168952101Y00000X, 101YP1600X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist