Doctor Name: | SCOTT D. MIMS |
NPI Number: | 1447388863 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW,CCS,LCAS,LCSW |
License Number: | 938 |
Business Practice Address: | 2150 Highway #56 East Creedmoor, NC - 27522 |
Business Phone Number: | 9102575522 |
Business Fax Number: | |
Mailing Address: | 1233 Marbank St, WAKE FOREST |
State: | NC |
Postal Code: | 275877924 |
Phone Number: | 9102575522 |
Fax Number: | |
NPI Enumeration Date: | 02/28/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 938 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |