Provider Demographics
NPI:1972318376
Name:SIMMS, MARK A SR (LGPC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:SIMMS
Suffix:SR
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9580 PEP RALLY LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5324
Mailing Address - Country:US
Mailing Address - Phone:240-396-7129
Mailing Address - Fax:
Practice Address - Street 1:9580 PEP RALLY LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5324
Practice Address - Country:US
Practice Address - Phone:240-396-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16113101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor