Provider Demographics
NPI:1942706171
Name:SIMPSON, CHARISSA L
Entity Type:Individual
Prefix:MRS
First Name:CHARISSA
Middle Name:L
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHARISSA
Other - Middle Name:L
Other - Last Name:WOOLCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 CEDAR ISLAND TRL
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-7512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1072 HWY 210
Practice Address - Street 2:SUITE B
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460
Practice Address - Country:US
Practice Address - Phone:570-854-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist