Healthcare Provider Details

I. General information

NPI: 1952724809
Provider Name (Legal Business Name): ANIZ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MITCHELL ST SW SUITE 200
ATLANTA GA
30303-3304
US

IV. Provider business mailing address

233 MITCHELL ST SW SUITE 200
ATLANTA GA
30303-3304
US

V. Phone/Fax

Practice location:
  • Phone: 404-521-2410
  • Fax: 404-521-2499
Mailing address:
  • Phone: 404-521-2410
  • Fax: 404-521-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ZINA AGE
Title or Position: CEO/PRESIDENT
Credential: LMSW, MA, MAC
Phone: 404-521-2410