Individual
ANGELA MYRISE MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13929 HARPER AVE, DETROIT, MI 48213-3672
(313) 371-0055
(313) 371-1409
Mailing address
14801 STANSBURY ST, DETROIT, MI 48227-3249
(313) 778-2627
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
520067619065
DRIVER LICENSE
MI
Enumeration date
03/06/2023
Last updated
03/06/2023
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