Provider Demographics
NPI:1003216995
Name:SIMMS, JEFFREY ALAN (LCMHC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:SIMMS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 MAHOGANY DR
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-9720
Mailing Address - Country:US
Mailing Address - Phone:336-989-9188
Mailing Address - Fax:
Practice Address - Street 1:8512 SIX FORKS RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3256
Practice Address - Country:US
Practice Address - Phone:919-277-0253
Practice Address - Fax:833-449-5270
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10896101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional