Individual
JACKIE SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSP, CIT3407
Contact information
Practice address
2274 WOODDALE BLVD, BATON ROUGE, LA 70806-1444
(225) 928-1088
Mailing address
2274 WOODDALE BLVD, BATON ROUGE, LA 70806-1444
(225) 928-1088
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CIT3407
LA
Other
Enumeration date
11/06/2015
Last updated
11/06/2015
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