MEDICARE: MS. CHRISTINE J. MEZZA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4731	GA

General Provider Information

NPI Number	:	1114103686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE J. MEZZA LPC

Provider Business Mailing Address
First Line	:	2260 GOLD MINE RD
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157
Country	:	US
Telephone Number	:	678-978-0464
Fax Number	:	770-505-3190

Provider Business Practice Location Address
First Line	:	2260 GOLD MINE RD
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157
Country	:	US
Telephone Number	:	678-978-0464
Fax Number	:	770-505-3190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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