Provider Demographics
NPI:1063797140
Name:BETHEA, SIMONE YVETTE (MA)
Entity type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:YVETTE
Last Name:BETHEA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:SIMONE
Other - Middle Name:YVETTE
Other - Last Name:ALDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:517 DELTONA BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8016
Mailing Address - Country:US
Mailing Address - Phone:386-473-4566
Mailing Address - Fax:
Practice Address - Street 1:517 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8016
Practice Address - Country:US
Practice Address - Phone:386-473-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health