Provider Demographics
NPI:1376037192
Name:SIMS, KHIEJANA CORINA
Entity Type:Individual
Prefix:
First Name:KHIEJANA
Middle Name:CORINA
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 ANNADALE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1956
Mailing Address - Country:US
Mailing Address - Phone:330-389-5938
Mailing Address - Fax:
Practice Address - Street 1:567 E TURKEYFOOT LAKE RD STE A-1
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-4107
Practice Address - Country:US
Practice Address - Phone:330-389-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.2004712104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator