Provider Demographics
NPI:1770798639
Name:SIMS, BILLY VANCE (LCSW, MHP)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:VANCE
Last Name:SIMS
Suffix:
Gender:M
Credentials:LCSW, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6004
Mailing Address - Country:US
Mailing Address - Phone:706-310-4096
Mailing Address - Fax:
Practice Address - Street 1:1030 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-6004
Practice Address - Country:US
Practice Address - Phone:706-310-9046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004080101YM0800X
GACSW0044651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health