Provider Demographics
NPI:1619414349
Name:SIMMONS, JULIE (LCMHC,LCAS,CCS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCMHC,LCAS,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3953B MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1403
Mailing Address - Country:US
Mailing Address - Phone:910-540-6749
Mailing Address - Fax:910-769-1772
Practice Address - Street 1:108 N KERR AVE STE C2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3439
Practice Address - Country:US
Practice Address - Phone:910-540-6749
Practice Address - Fax:910-769-1772
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21056101YA0400X
NC13093101YM0800X, 101YP2500X, 101Y00000X
NCA13093101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor