Provider Demographics
NPI:1437638301
Name:SIMMONS, MALCOLM U
Entity Type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:U
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 EDENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7099
Mailing Address - Country:US
Mailing Address - Phone:252-495-8454
Mailing Address - Fax:
Practice Address - Street 1:697 EDENBROOK DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7099
Practice Address - Country:US
Practice Address - Phone:252-495-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)