Provider Demographics
NPI:1912280413
Name:SIMPSON, LUNA MONIQUE (CCMA)
Entity type:Individual
Prefix:MRS
First Name:LUNA
Middle Name:MONIQUE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:MRS
Other - First Name:LUNA
Other - Middle Name:MONIQUE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RMA
Mailing Address - Street 1:18621 SNOWDEN ST # 2B
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1363
Mailing Address - Country:US
Mailing Address - Phone:313-502-1635
Mailing Address - Fax:
Practice Address - Street 1:18621 SNOWDEN ST
Practice Address - Street 2:2B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1363
Practice Address - Country:US
Practice Address - Phone:313-502-1635
Practice Address - Fax:586-486-5772
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 175F00000X
MI7471804372500000X
MID8J6B5T7374700000X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath
No372500000XNursing Service Related ProvidersChore Provider
No374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7471804Medicaid