Basic Information
| Provider Information | |||||||||
| NPI: | 1124287263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | YOLONDA | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | CERTIFIED COUNSELOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5838 S. OVERHILL DRIVE | ||||||||
| Address2: | SUITE 2B | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232950009 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6666 GREEN VALLEY CIR | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902307068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108465270 | ||||||||
| FaxNumber: | 3108465278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 06/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP1600X | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.