Provider Demographics
NPI:1306004445
Name:MIMMS, ELIZABETH M (CSW)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:MIMMS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 BRIARCREST DRIVE
Mailing Address - Street 2:UNIT 171
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6763
Mailing Address - Country:US
Mailing Address - Phone:734-604-4167
Mailing Address - Fax:
Practice Address - Street 1:325 BRIARCREST DR
Practice Address - Street 2:UNIT 171
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6763
Practice Address - Country:US
Practice Address - Phone:734-604-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010042261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801004226OtherSTATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH BOARD 0F SOCIAL WORK