Individual
COURTNEY DANIEL MIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5425 PEACHTREE PKWY, PEACHTREE CORNERS, GA 30092-6536
(855) 850-0274
Mailing address
469 SAN REMO AVE, SAN JACINTO, CA 92582-3099
(909) 709-2253
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/02/2018
Last updated
08/14/2024
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