Provider Demographics
NPI:1821627563
Name:SIMMONS, QUINEVERE INEZ (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:QUINEVERE
Middle Name:INEZ
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:MS
Other - First Name:QUINEVERE
Other - Middle Name:INEZ
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3710 SHANNON RD # 51576
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6327
Mailing Address - Country:US
Mailing Address - Phone:984-710-1934
Mailing Address - Fax:
Practice Address - Street 1:3710 SHANNON RD # 51576
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6327
Practice Address - Country:US
Practice Address - Phone:984-710-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP012883104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker