Provider Demographics
NPI:1710495056
Name:SIMMONS, ANN MARIE (LISW-CP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HALTON RD STE J
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3498
Mailing Address - Country:US
Mailing Address - Phone:864-664-2710
Mailing Address - Fax:
Practice Address - Street 1:301 HALTON RD STE J
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3498
Practice Address - Country:US
Practice Address - Phone:864-664-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC112831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical