Provider Demographics
NPI:1255100681
Name:TIMS, RAHEIM
Entity type:Individual
Prefix:
First Name:RAHEIM
Middle Name:
Last Name:TIMS
Suffix:
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 1:43 RIVES RD STE A
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9427
Mailing Address - Country:US
Mailing Address - Phone:804-536-0105
Mailing Address - Fax:
Practice Address - Street 1:1808 DUBLIN ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-6209
Practice Address - Country:US
Practice Address - Phone:804-536-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732010001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health