Provider Demographics
NPI:1861791733
Name:SIMMONS, LEEANN (LAPC)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 ESTONIAN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2091
Mailing Address - Country:US
Mailing Address - Phone:404-543-8074
Mailing Address - Fax:
Practice Address - Street 1:4944 ESTONIAN DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2091
Practice Address - Country:US
Practice Address - Phone:404-543-8074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002880101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor