Individual
PAMELA MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4757 N 76TH ST, MILWAUKEE, WI 53218-4732
(414) 539-6999
Mailing address
4757 N 76TH ST, MILWAUKEE, WI 53218-4732
(414) 539-6999
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20319-130
WI
101YM0800X
Mental Health Counselor
20319-130
WI
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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