Provider Demographics
NPI:1023299039
Name:SIMS, JEREMY BERNARD (MSW, PLCSW THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:BERNARD
Last Name:SIMS
Suffix:
Gender:M
Credentials:MSW, PLCSW THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 EASTOVER RIDGE DR
Mailing Address - Street 2:UNIT 525
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1464
Mailing Address - Country:US
Mailing Address - Phone:704-224-6805
Mailing Address - Fax:704-900-5335
Practice Address - Street 1:1720 HAMPSHIRE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-7211
Practice Address - Country:US
Practice Address - Phone:704-630-6634
Practice Address - Fax:866-828-5500
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0039241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical