Individual
VANESSA SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
333 REVOLUTIONARY TRL, FAIRFAX, SC 29827-7109
(803) 632-2533
(803) 632-3285
Mailing address
86 WREN ST, BARNWELL, SC 29812-1529
(803) 259-5762
(803) 259-3250
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6524
SC
101YA0400X
Addiction (Substance Use Disorder) Counselor
6524
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6524
MEDICAL LICENSE
SC
05
—
AD01AK
—
SC
Enumeration date
10/20/2014
Last updated
01/11/2024
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