Provider Demographics
NPI:1063097947
Name:SIMS, ALEXIS (MA, ED S)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:MA, ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BLUE SPIRE CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1740
Mailing Address - Country:US
Mailing Address - Phone:443-648-1214
Mailing Address - Fax:
Practice Address - Street 1:55 BLUE SPIRE CIR
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-1740
Practice Address - Country:US
Practice Address - Phone:443-648-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty