Provider Demographics
NPI:1134453905
Name:SIMMONS, CHARMAINE J (MAMFT)
Entity type:Individual
Prefix:MISS
First Name:CHARMAINE
Middle Name:J
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 VINOY BLVD
Mailing Address - Street 2:#106
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4008
Mailing Address - Country:US
Mailing Address - Phone:678-201-9773
Mailing Address - Fax:
Practice Address - Street 1:845 CHURCH ST N
Practice Address - Street 2:STE 305
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4300
Practice Address - Country:US
Practice Address - Phone:704-262-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health