Provider Demographics
NPI:1083366736
Name:WIMS, CORANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:CORANDA
Middle Name:
Last Name:WIMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CORANDA
Other - Middle Name:
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIT 5024 BOX PSC
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319-5024
Mailing Address - Country:US
Mailing Address - Phone:153-226-2123
Mailing Address - Fax:
Practice Address - Street 1:PSC 76 UNIT 5024
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:93619
Practice Address - Country:UM
Practice Address - Phone:315-226-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical