Provider Demographics
NPI:1407491582
Name:SIMS, ANGELA JEAN (MSSA, LSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:SIMS
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JEAN
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSSA, LSW
Mailing Address - Street 1:54 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2345
Mailing Address - Country:US
Mailing Address - Phone:234-266-0203
Mailing Address - Fax:234-200-0584
Practice Address - Street 1:180 HIGH ST STE D
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1874
Practice Address - Country:US
Practice Address - Phone:234-266-0203
Practice Address - Fax:234-200-0584
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1904526104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker