Provider Demographics
NPI:1376378000
Name:SIMS, RACQUEL LASHANTA
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:LASHANTA
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:LASHANTA
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:440 KNOX ABBOTT DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-4353
Mailing Address - Country:US
Mailing Address - Phone:843-501-1099
Mailing Address - Fax:
Practice Address - Street 1:4605 MONTICELLO RD BLDG B1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-4156
Practice Address - Country:US
Practice Address - Phone:803-714-0266
Practice Address - Fax:803-753-6333
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10213101YP2500X
SC8203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health