Provider Demographics
NPI:1447388863
Name:MIMS, SCOTT D (MSW,CCS,LCAS,LCSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:MIMS
Suffix:
Gender:M
Credentials:MSW,CCS,LCAS,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 MARBANK ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7924
Mailing Address - Country:US
Mailing Address - Phone:910-257-5522
Mailing Address - Fax:
Practice Address - Street 1:2150 HIGHWAY #56 EAST
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:910-257-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC938101YA0400X
NCC0010151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical