Provider Demographics
NPI:1750953311
Name:SIMPKINS, DESIRI-ILANA RENEL
Entity type:Individual
Prefix:
First Name:DESIRI-ILANA
Middle Name:RENEL
Last Name:SIMPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5117
Mailing Address - Country:US
Mailing Address - Phone:478-501-4823
Mailing Address - Fax:
Practice Address - Street 1:107 JACKSON ST
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5117
Practice Address - Country:US
Practice Address - Phone:478-501-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional