Provider Demographics
NPI:1871534065
Name:SIMPSON, 111, JOHN CHILDS (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHILDS
Last Name:SIMPSON, 111
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GREENWICH RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2355
Mailing Address - Country:US
Mailing Address - Phone:704-362-7007
Mailing Address - Fax:704-362-7007
Practice Address - Street 1:121 GREENWICH RD
Practice Address - Street 2:SUITE 215
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2355
Practice Address - Country:US
Practice Address - Phone:704-362-7007
Practice Address - Fax:704-362-7007
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0745103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04674OtherBLUE CROSS BLUE SHIELD
NC6001077Medicaid
NC2812636CMedicare PIN