Provider Demographics
NPI:1720291933
Name:SIMMONS, ANGELA LEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LEE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 SW 34TH ST
Mailing Address - Street 2:APT. B15
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7582
Mailing Address - Country:US
Mailing Address - Phone:502-291-4121
Mailing Address - Fax:
Practice Address - Street 1:7019 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3145
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-379-4082
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical