Provider Demographics
NPI:1518536002
Name:SIMMONS, JANICE (RBT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 BOLL WEEVIL CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-1317
Mailing Address - Country:US
Mailing Address - Phone:334-661-7635
Mailing Address - Fax:
Practice Address - Street 1:1016 BOLL WEEVIL CIR STE 2
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1317
Practice Address - Country:US
Practice Address - Phone:334-661-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician