Basic Information
| Provider Information | |||||||||
| NPI: | 1366954505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL SIMMONS | ||||||||
| FirstName: | ANGELOUS | ||||||||
| MiddleName: | DANETTA | ||||||||
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| Credential: | RW8444 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1124 BAKER ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933054322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613279376 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1124 BAKER ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933054322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613279376 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2017 | ||||||||
| LastUpdateDate: | 12/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.