Healthcare Provider Details

I. General information

NPI: 1447697537
Provider Name (Legal Business Name): KRISTIN MIZE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 PEELER RD SUITE D.
DUNWOODY GA
30338-5710
US

IV. Provider business mailing address

2655 DALLAS HWY SW STE 310
MARIETTA GA
30064-7518
US

V. Phone/Fax

Practice location:
  • Phone: 470-798-7285
  • Fax:
Mailing address:
  • Phone: 404-725-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004125
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: