Provider Demographics
NPI:1356768451
Name:SIMMONS, MARIE ANTOINETTE (MA, LCPC, NCC)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANTOINETTE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MA, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SUNSHINE PL APT H
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4690
Mailing Address - Country:US
Mailing Address - Phone:410-294-7356
Mailing Address - Fax:
Practice Address - Street 1:305 SUNSHINE PL APT H
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4690
Practice Address - Country:US
Practice Address - Phone:410-294-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional