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NPI Code Detail

MEDICARE: MS. ANTOINETTE MIMS CHW

MEDICARE: MS. ANTOINETTE MIMS CHW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1205068285
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANTOINETTE MIMS CHW
Provider Business Mailing Address
First Line : 1240 W OWENS AVE STE 1
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2452
Country : US
Telephone Number : 678-812-9764
Fax Number :
Provider Business Practice Location Address
First Line : 1240 W OWENS AVE STE 1
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2452
Country : US
Telephone Number : 678-812-9764
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2009
Last Update Date : 04/12/2024

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Directions to “ MS. ANTOINETTE MIMS CHW” Practice Location

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