Provider Demographics
NPI:1154573988
Name:MIMS, LESLEY MARIE (BA)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:MARIE
Last Name:MIMS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 BREWSTER LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2638
Mailing Address - Country:US
Mailing Address - Phone:910-785-7877
Mailing Address - Fax:
Practice Address - Street 1:716 BREWSTER LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2638
Practice Address - Country:US
Practice Address - Phone:910-785-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)