Individual
CHRISTALLE SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1415 SUMMERVILLE MAMERS RD, LILLINGTON, NC 27546-2754
(910) 658-2081
Mailing address
1415 SUMMERVILLE MAMERS RD, LILLINGTON, NC 27546-8911
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/22/2017
Last updated
08/22/2017
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