Provider Information for 1588097109
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ENRIQUE ALFREDO SIMMONS LCPC
Sex: Male
NPI: 1588097109
Last Updated: 2023-09-27
Certification Date: 2023-09-27
Certification Date: 2023-09-27
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1588097109 | ||||||||||||||||||||
| Enumeration Date | 2013-08-19 | ||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Mailing Address | 2020 ROANOKE ST HYATTSVILLE, MD 20782-1610 United States Phone: 301-509-8403 | Fax:301-422-1652 | ||||||||||||||||||||
| Primary Practice Address | 2020 ROANOKE ST HYATTSVILLE, MD 20782-1610 United States Phone: 301-509-8403 | Fax:301-422-1652 | ||||||||||||||||||||
| Secondary Practice Address(es) | 1221 TAYLOR ST NW | ||||||||||||||||||||
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