Healthcare Provider Details

I. General information

NPI: 1982965174
Provider Name (Legal Business Name): ANIZ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/04/2012
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:
Mailing address:
  • Phone: 404-521-2410
  • Fax:

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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. ZINA M AGE
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 404-521-2410