Healthcare Provider Details

I. General information

NPI: 1124887047
Provider Name (Legal Business Name): MEZTLI COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S SCOTT ST APT 329
ARLINGTON VA
22204-6281
US

IV. Provider business mailing address

1301 S SCOTT ST APT 329
ARLINGTON VA
22204-6281
US

V. Phone/Fax

Practice location:
  • Phone: 917-292-8446
  • Fax:
Mailing address:
  • Phone: 917-292-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ZAMIR O BRIDGMAN
Title or Position: THERAPIST
Credential: MSW
Phone: 917-292-8446