Provider Demographics
NPI:1629576590
Name:SIMMERS, STEPHEN LYNN (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:LYNN
Last Name:SIMMERS
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:LIGHTFOOT
Mailing Address - State:VA
Mailing Address - Zip Code:23090-0087
Mailing Address - Country:US
Mailing Address - Phone:757-941-5095
Mailing Address - Fax:757-565-2947
Practice Address - Street 1:5477 MOORETOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2108
Practice Address - Country:US
Practice Address - Phone:757-565-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional