Individual
CHARLOTTE MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11705 DEPUTY YAMAMOTO PL, LYNWOOD, CA 90262-4031
(323) 242-5000
Mailing address
11705 DEPUTY YAMAMOTO PL, LYNWOOD, CA 90262-4031
(323) 242-5000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
01/24/2017
Last updated
04/09/2026
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