Provider Demographics
NPI:1336031483
Name:WALDON SIMMONS, EBONI NICHOLE
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:NICHOLE
Last Name:WALDON SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 ADDISON CIR # 1070
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3308
Mailing Address - Country:US
Mailing Address - Phone:940-224-1888
Mailing Address - Fax:
Practice Address - Street 1:5015 ADDISON CIR # 1070
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3308
Practice Address - Country:US
Practice Address - Phone:940-224-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional