Individual
SAMUEL SIMMONS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
3442 25TH AVE S, MINNEAPOLIS, MN 55406-2504
(612) 721-0106
Mailing address
3442 25TH AVE S, MINNEAPOLIS, MN 55406-2504
(612) 721-0106
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300322
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300322
LADC
MN
Enumeration date
07/28/2015
Last updated
07/28/2015
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