Provider Demographics
NPI:1811605256
Name:MIMBS, AVA C (MS, NCC, LPC, C-DBT)
Entity type:Individual
Prefix:MS
First Name:AVA
Middle Name:C
Last Name:MIMBS
Suffix:
Gender:F
Credentials:MS, NCC, LPC, C-DBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 FOREST PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5017
Mailing Address - Country:US
Mailing Address - Phone:423-243-0088
Mailing Address - Fax:
Practice Address - Street 1:4321 FOREST PLAZA DR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5017
Practice Address - Country:US
Practice Address - Phone:423-243-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty