Provider Demographics
NPI:1114709961
Name:SIMS, ATHELA MARIE (QBHS)
Entity Type:Individual
Prefix:MRS
First Name:ATHELA
Middle Name:MARIE
Last Name:SIMS
Suffix:
Gender:F
Credentials:QBHS
Other - Prefix:MRS
Other - First Name:ATHELA
Other - Middle Name:MARIE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5460 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4074
Mailing Address - Country:US
Mailing Address - Phone:614-568-8236
Mailing Address - Fax:614-725-2829
Practice Address - Street 1:5460 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4074
Practice Address - Country:US
Practice Address - Phone:614-568-8236
Practice Address - Fax:614-725-2829
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHQBHS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)