Provider Demographics
NPI:1477983898
Name:SIMMS, STEPHANIE (MA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SIMMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 AVALON PARK EAST BLVD STE 2024
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7760
Mailing Address - Country:US
Mailing Address - Phone:407-476-7450
Mailing Address - Fax:
Practice Address - Street 1:3662 AVALON PARK EAST BLVD STE 2024
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7760
Practice Address - Country:US
Practice Address - Phone:407-476-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health