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Individual

MALANNA SIMMONS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
6249 HAZEL AVE, PHILADELPHIA, PA 19143-1022
(612) 413-4087
Mailing address
6249 HAZEL AVE, PHILADELPHIA, PA 19143-1022
(612) 413-4087

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
104100000X
Social Worker
Primary
SW139002
PA
1041C0700X
Clinical Social Worker
CW024839
PA
251S00000X
Community/Behavioral Health Agency

Other

Enumeration date
06/18/2021
Last updated
06/14/2024
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