Provider Demographics
NPI:1790156255
Name:SOLOMON SIMPSON, LYSSA EILEEN
Entity type:Individual
Prefix:MS
First Name:LYSSA
Middle Name:EILEEN
Last Name:SOLOMON SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1124
Mailing Address - Street 2:
Mailing Address - City:REDAN
Mailing Address - State:GA
Mailing Address - Zip Code:30074-1124
Mailing Address - Country:US
Mailing Address - Phone:404-553-3597
Mailing Address - Fax:
Practice Address - Street 1:1400 SOUTHLAKE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1756
Practice Address - Country:US
Practice Address - Phone:404-553-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health