Basic Information
| Provider Information | |||||||||
| NPI: | 1972709459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMS | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | PCC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 CATALINA BLVD | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446911301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302642871 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2803 AKRON RD | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446917904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302643232 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YP2500X | E0003779 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.