Provider Demographics
NPI:1730602517
Name:SIMPSON, KISHA LADAWN (LMSW)
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:LADAWN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KISHA
Other - Middle Name:LADAWN
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18688 W 13 MILE RD APT 5
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5271
Mailing Address - Country:US
Mailing Address - Phone:313-516-1098
Mailing Address - Fax:
Practice Address - Street 1:11043 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1333
Practice Address - Country:US
Practice Address - Phone:313-516-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010927101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty