Provider Demographics
NPI:1679210660
Name:SIMMONS, TIYON LAVON (LCMHCA)
Entity Type:Individual
Prefix:MR
First Name:TIYON
Middle Name:LAVON
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217A PEYTON CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8231
Mailing Address - Country:US
Mailing Address - Phone:252-382-9901
Mailing Address - Fax:
Practice Address - Street 1:607 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2645
Practice Address - Country:US
Practice Address - Phone:252-792-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17444225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty