Healthcare Provider Details

I. General information

NPI: 1750924049
Provider Name (Legal Business Name): LINDA RAYE MIZZELLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2019
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ARBOR DR
GREENVILLE NC
27858-9550
US

IV. Provider business mailing address

121 ARBOR DR
GREENVILLE NC
27858-9550
US

V. Phone/Fax

Practice location:
  • Phone: 252-717-3097
  • Fax:
Mailing address:
  • Phone: 252-717-3097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012539
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: