Provider Demographics
NPI:1265912398
Name:MIMS, LAKEIDRA T (LMSW)
Entity type:Individual
Prefix:MS
First Name:LAKEIDRA
Middle Name:T
Last Name:MIMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CCB 4FL 1720 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-2050
Mailing Address - Country:US
Mailing Address - Phone:205-975-8950
Mailing Address - Fax:
Practice Address - Street 1:UAB COMMUNITY PSYCHIATRY 908 20TH STREET SOUTH RM 487
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-2610
Practice Address - Country:US
Practice Address - Phone:205-934-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4449G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical