Provider Demographics
NPI:1184895245
Name:LIVINGSTON, SIMONE NICOLE
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:NICOLE
Last Name:LIVINGSTON
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 1:8109 HARFORD RD
Mailing Address - Street 2:6
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-9205
Mailing Address - Country:US
Mailing Address - Phone:410-665-2900
Mailing Address - Fax:410-665-2933
Practice Address - Street 1:8109 HARFORD RD
Practice Address - Street 2:6
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-9205
Practice Address - Country:US
Practice Address - Phone:410-665-2900
Practice Address - Fax:410-665-2933
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional