Provider Demographics
NPI:1588955181
Name:SIMMONS, JULIA MARIAN (PHD, LPC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIAN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 RECTOR RD
Mailing Address - Street 2:
Mailing Address - City:ENNICE
Mailing Address - State:NC
Mailing Address - Zip Code:28623-9115
Mailing Address - Country:US
Mailing Address - Phone:336-372-6083
Mailing Address - Fax:336-372-1930
Practice Address - Street 1:393 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-8896
Practice Address - Country:US
Practice Address - Phone:336-372-6083
Practice Address - Fax:336-372-1930
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3514101YM0800X
VA0701004400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health