Provider Demographics
NPI:1205127867
Name:WIMMS, HARRIETTE ERNESTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:HARRIETTE
Middle Name:ERNESTINE
Last Name:WIMMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4514
Mailing Address - Country:US
Mailing Address - Phone:410-337-7772
Mailing Address - Fax:
Practice Address - Street 1:8501 LASALLE ROAD
Practice Address - Street 2:SUITE 115
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-4514
Practice Address - Country:US
Practice Address - Phone:410-337-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04763103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist