Provider Demographics
NPI:1952055477
Name:SIMMONS, EVELYN M
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:M
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 1:85 ROCKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-9511
Mailing Address - Country:US
Mailing Address - Phone:984-289-3081
Mailing Address - Fax:
Practice Address - Street 1:1310 CORPORATION PKWY STE H
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1363
Practice Address - Country:US
Practice Address - Phone:919-256-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000031194928106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician