MEDICARE: MRS. DONNA MARIE MIZWA MA, LPC, CAADC

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	6401007277	MI

General Provider Information

NPI Number	:	1124126016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA MARIE MIZWA MA, LPC, CAADC

Provider Business Mailing Address
First Line	:	18661 WIGEON DR
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1167
Country	:	US
Telephone Number	:	586-484-1438
Fax Number	:

Provider Business Practice Location Address
First Line	:	42450 GARFIELD RD STE B
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5040
Country	:	US
Telephone Number	:	586-484-1438
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/05/2026

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