Provider Demographics
NPI:1942311626
Name:SIMMONS, BEVERLY M (LCSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 BARRETT DR STE 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6623
Mailing Address - Country:US
Mailing Address - Phone:919-824-9102
Mailing Address - Fax:919-883-4515
Practice Address - Street 1:4016 BARRETT DR STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6623
Practice Address - Country:US
Practice Address - Phone:919-824-9102
Practice Address - Fax:919-883-4515
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0053871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC005387OtherNC LICENSE