1215564851 NPI number — MRS. LAURIE HALSEY SIMMONS LCSW

Table of content: MRS. LAURIE HALSEY SIMMONS LCSW (NPI 1215564851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215564851 NPI number — MRS. LAURIE HALSEY SIMMONS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMONS
Provider First Name:
LAURIE
Provider Middle Name:
HALSEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALSEY
Provider Other First Name:
LAURIE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215564851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 629
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDENTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27932-0629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-482-6347
Provider Business Mailing Address Fax Number:
252-482-6381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 VIRGINIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27932-9668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-482-6347
Provider Business Practice Location Address Fax Number:
252-482-6381
Provider Enumeration Date:
03/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C003573 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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