Provider Demographics
NPI:1912703497
Name:SIMONS, OLIVIA MACKENZIE (RBT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MACKENZIE
Last Name:SIMONS
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S WILLIAMS ST APT 505
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-6334
Mailing Address - Country:US
Mailing Address - Phone:610-324-1254
Mailing Address - Fax:
Practice Address - Street 1:1030 OLYMPIA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4698
Practice Address - Country:US
Practice Address - Phone:610-324-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst