Provider Demographics
NPI:1457780843
Name:SIMMONS, KIMBERLY O (LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:O
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 BRIDFORD PKWY APT 5B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2675
Mailing Address - Country:US
Mailing Address - Phone:301-256-8280
Mailing Address - Fax:
Practice Address - Street 1:1505 BRIDFORD PKWY APT 5B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2675
Practice Address - Country:US
Practice Address - Phone:301-256-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500791551041S0200X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker