Provider Demographics
NPI:1659786531
Name:SIMUNEK, GRACE MARTIN (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARTIN
Last Name:SIMUNEK
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4548 EMORY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2435
Mailing Address - Country:US
Mailing Address - Phone:774-930-9246
Mailing Address - Fax:
Practice Address - Street 1:4548 EMORY LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2435
Practice Address - Country:US
Practice Address - Phone:774-930-9246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-14-15400103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst