Individual
MRS. SHANTASIA M. A, SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
403 STONY LANDING RD, MONCKS CORNER, SC 29461-3967
(843) 761-8282
(843) 761-7308
Mailing address
PO BOX 1030, MONCKS CORNER, SC 29461-1030
(843) 761-8282
(843) 761-7308
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
218124
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
435201
—
SC
Enumeration date
02/11/2016
Last updated
02/11/2016
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