Provider Demographics
NPI:1023507605
Name:SIMMONS, ANDREA KAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KAE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 WHITE TAIL ROAD
Mailing Address - Street 2:
Mailing Address - City:GLADY
Mailing Address - State:WV
Mailing Address - Zip Code:26268
Mailing Address - Country:US
Mailing Address - Phone:304-621-7624
Mailing Address - Fax:
Practice Address - Street 1:ST GEORGE MEDICAL CLINIC
Practice Address - Street 2:138 CRESTVIEW DRIVE
Practice Address - City:HAMBLETON
Practice Address - State:WV
Practice Address - Zip Code:26269
Practice Address - Country:US
Practice Address - Phone:304-478-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP009384581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical