Provider Demographics
NPI:1821113366
Name:SIMMONS-FONNER, LAURA R (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:R
Last Name:SIMMONS-FONNER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:R
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10455 WHITE GRANITE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2764
Mailing Address - Country:US
Mailing Address - Phone:703-536-9000
Mailing Address - Fax:
Practice Address - Street 1:10455 WHITE GRANITE DR STE 400
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2764
Practice Address - Country:US
Practice Address - Phone:703-536-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945247Medicaid
VA292848OtherAMERIGROUP
VA105700OtherBLUE CROSS BLUE SHIELD