Individual
DR. JONATHAN ALAN SIMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1506 AZALEA DRIVE, SUITE 602, SURFSIDE BEACH, SC 29575
(843) 828-0502
(843) 828-4402
Mailing address
PO BOX 859, PAWLEYS ISLAND, SC 29585
(843) 828-0502
(843) 828-4402
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
639
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PS0245
—
SC
Enumeration date
08/29/2006
Last updated
12/22/2010
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