Provider Demographics
NPI:1801407242
Name:SIMMONS, SOPHIA IRENE
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:IRENE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 NAPA VALLEY CORPORATE DR
Mailing Address - Street 2:A
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2923
Mailing Address - Country:US
Mailing Address - Phone:707-299-1760
Mailing Address - Fax:
Practice Address - Street 1:2571 NAPA VALLEY CORPORATE DR
Practice Address - Street 2:A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-9455
Practice Address - Country:US
Practice Address - Phone:707-299-1958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician