Provider Demographics
NPI:1790975506
Name:MIMS-LEWIS, SONJA (LADC)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:MIMS-LEWIS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 UPPER 55TH ST E APT 206
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-1517
Mailing Address - Country:US
Mailing Address - Phone:651-235-2130
Mailing Address - Fax:
Practice Address - Street 1:1475 UPPER 55TH ST E APT 206
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1517
Practice Address - Country:US
Practice Address - Phone:651-235-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302275101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)