Provider Demographics
NPI:1114950730
Name:SIMBULAN, DONNA M (LMSW, ACSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:SIMBULAN
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 W MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3016
Mailing Address - Country:US
Mailing Address - Phone:269-660-3900
Mailing Address - Fax:269-660-3899
Practice Address - Street 1:36 W MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3016
Practice Address - Country:US
Practice Address - Phone:269-660-3900
Practice Address - Fax:269-660-3899
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010683071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical