Provider Demographics
NPI:1891003356
Name:MIMS, ERNEST JAMES SR
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:JAMES
Last Name:MIMS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 DONNER AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3276
Mailing Address - Country:US
Mailing Address - Phone:415-226-1775
Mailing Address - Fax:415-822-8262
Practice Address - Street 1:1601 DONNER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-3276
Practice Address - Country:US
Practice Address - Phone:415-266-1775
Practice Address - Fax:415-822-8262
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)