Provider Demographics
NPI:1417072398
Name:SIMMONS, GWEN S (EDD, LPC, NBC, MAC)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:S
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:EDD, LPC, NBC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 CASTLEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-8306
Mailing Address - Country:US
Mailing Address - Phone:910-245-2580
Mailing Address - Fax:
Practice Address - Street 1:867 CASTLEBERRY CT
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394-8306
Practice Address - Country:US
Practice Address - Phone:910-245-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCCAS 104101YA0400X
NCLPC 2013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional