Individual
KOYONNE MIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4160 WOODWARD AVE, DETROIT, MI 48201-2027
(313) 757-1922
Mailing address
4160 WOODWARD AVE, DETROIT, MI 48201-2027
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301015553
MI
Other
Enumeration date
09/18/2012
Last updated
06/24/2015
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