Provider Demographics
NPI:1881068302
Name:SIMON, DARICA
Entity type:Individual
Prefix:
First Name:DARICA
Middle Name:
Last Name:SIMON
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 1:456 WILTON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6567
Mailing Address - Country:US
Mailing Address - Phone:225-266-3606
Mailing Address - Fax:225-216-8669
Practice Address - Street 1:456 WILTON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6567
Practice Address - Country:US
Practice Address - Phone:225-266-3606
Practice Address - Fax:225-216-8669
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health