Healthcare Provider Details

I. General information

NPI: 1154231942
Provider Name (Legal Business Name): MISTY NICHOLS MIZE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7682 NICHOLS CRANFORD RD
DENTON NC
27239-9416
US

IV. Provider business mailing address

7682 NICHOLS CRANFORD RD
DENTON NC
27239-9416
US

V. Phone/Fax

Practice location:
  • Phone: 336-964-1312
  • Fax: 336-673-8301
Mailing address:
  • Phone: 336-964-1312
  • Fax: 336-673-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC016407
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: