Provider Demographics
NPI:1598275000
Name:SIMMONS HOBSON, ALISHA (MPA)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:SIMMONS HOBSON
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 COBBLESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-2083
Mailing Address - Country:US
Mailing Address - Phone:843-781-3468
Mailing Address - Fax:
Practice Address - Street 1:1043 COBBLESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-2083
Practice Address - Country:US
Practice Address - Phone:843-781-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X, 251B00000X, 251S00000X, 174H00000X
NCP0198851041C0700X
SC16356104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No174H00000XOther Service ProvidersHealth Educator