Provider Demographics
NPI:1447697537
Name:MIZE, KRISTIN (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MIZE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 DALLAS HWY SW STE 310
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-7518
Mailing Address - Country:US
Mailing Address - Phone:404-725-0109
Mailing Address - Fax:
Practice Address - Street 1:1845 PEELER RD
Practice Address - Street 2:SUITE D.
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5710
Practice Address - Country:US
Practice Address - Phone:470-798-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0041251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical