Provider Demographics
NPI:1336839141
Name:SIMMONS, QIANNA EBONY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:QIANNA
Middle Name:EBONY
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 ALDER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-8352
Mailing Address - Country:US
Mailing Address - Phone:704-737-1684
Mailing Address - Fax:
Practice Address - Street 1:11020 DAVID TAYLOR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1101
Practice Address - Country:US
Practice Address - Phone:704-737-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical