Healthcare Provider Details

I. General information

NPI: 1285467753
Provider Name (Legal Business Name): ANGELA H MIZELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA NICOLE HIGGINBOTHAM

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 JENA ST
NEW ORLEANS LA
70115-6322
US

IV. Provider business mailing address

6026 CHAMBERLAIN DR
NEW ORLEANS LA
70122-2730
US

V. Phone/Fax

Practice location:
  • Phone: 504-383-3535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17304
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: