Provider Demographics
NPI:1598442543
Name:SIMMONS, LINDA WRIGHT (DMIN, MA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:WRIGHT
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:DMIN, MA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JOANN
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:641 BLAIRSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4713
Mailing Address - Country:US
Mailing Address - Phone:407-421-9034
Mailing Address - Fax:
Practice Address - Street 1:121 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3429
Practice Address - Country:US
Practice Address - Phone:407-421-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health