| Doctor Name: | MARK A SIMONETTA |
| NPI Number: | 1376577510 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 0904005690 |
| Business Practice Address: | 207 N 4th Ave Hopewell, VA - 238602503 |
| Business Phone Number: | 8045410918 |
| Business Fax Number: | 8045417924 |
| Mailing Address: | 207 N 4th Ave, HOPEWELL |
| State: | VA |
| Postal Code: | 238602503 |
| Phone Number: | 8045410918 |
| Fax Number: | 8045417924 |
| NPI Enumeration Date: | 07/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0904005690 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |