Provider Demographics
NPI:1922155647
Name:SIMON, SALEEB (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SALEEB
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4591 MONTAUK RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3934
Mailing Address - Country:US
Mailing Address - Phone:770-339-5107
Mailing Address - Fax:770-822-1698
Practice Address - Street 1:175 GWINNETT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8444
Practice Address - Country:US
Practice Address - Phone:770-339-5107
Practice Address - Fax:770-822-1698
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001977101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor