Basic Information
| Provider Information | |||||||||
| NPI: | 1326768169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIZE COUNSELING SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 CORDER RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4785514714 | ||||||||
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| Practice Location | |||||||||
| Address1: | 402 CORDER RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4785514714 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2022 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | MIZE | ||||||||
| AuthorizedOfficialFirstName: | AMBER | ||||||||
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| AuthorizedOfficialTitleorPosition: | LCSW | ||||||||
| AuthorizedOfficialTelephone: | 4785514714 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.