Provider Demographics
NPI:1407106040
Name:SIMMONS, MELVINIK LAMONTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELVINIK
Middle Name:LAMONTE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELVINK
Other - Middle Name:LAMONTE
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3444 ROSS MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8199
Mailing Address - Country:US
Mailing Address - Phone:843-279-4393
Mailing Address - Fax:
Practice Address - Street 1:3444 ROSS MORGAN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8199
Practice Address - Country:US
Practice Address - Phone:843-279-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health