Provider Demographics
NPI:1487189643
Name:WIMS, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:WIMS
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 1:8149 E AVERY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1721
Mailing Address - Country:US
Mailing Address - Phone:317-223-8544
Mailing Address - Fax:
Practice Address - Street 1:8202 CLEARVISTA PKWY STE 6A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1442
Practice Address - Country:US
Practice Address - Phone:317-588-6538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst