Provider Demographics
NPI:1184026213
Name:MIMS, SONIA (PHD, MAT)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MIMS
Suffix:
Gender:F
Credentials:PHD, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N UNION ST.
Mailing Address - Street 2:ST 110
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9134 RUBY LOCKHART BLVD
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-2663
Practice Address - Country:US
Practice Address - Phone:202-643-5384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007492103TC0700X
MD06561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical