Healthcare Provider Details

I. General information

NPI: 1770234320
Provider Name (Legal Business Name): BROOKE SMITH MIZE MA, NCC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 BUSINESS PARK DR STE A
EDEN NC
27288-6461
US

IV. Provider business mailing address

408 ROBERTS RD
EDEN NC
27288-7645
US

V. Phone/Fax

Practice location:
  • Phone: 336-344-1594
  • Fax:
Mailing address:
  • Phone: 336-344-1594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17273
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: