Provider Demographics
NPI:1457502882
Name:SIMMONS, TASHA JACKSON (PSY D)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:JACKSON
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W 21ST ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2130
Mailing Address - Country:US
Mailing Address - Phone:757-622-9852
Mailing Address - Fax:757-622-4033
Practice Address - Street 1:327 W 21ST ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2130
Practice Address - Country:US
Practice Address - Phone:757-622-9852
Practice Address - Fax:757-622-4033
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004002103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical