Organization
YOUR SUPPORT SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN SIMMS LCPC (CEO)
(301) 209-7233
Entity
Organization
Contact information
Practice address
10111 MARTIN LUTHER KING JR HWY STE 104, BOWIE, MD 20720-4225
(301) 209-7233
Mailing address
10111 MARTIN LUTHER KING JR HWY STE 104, BOWIE, MD 20720-4225
(301) 209-7233
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
660009300
—
MD
Enumeration date
12/05/2017
Last updated
08/04/2023
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