Provider Demographics
NPI:1730629320
Name:MIZELLE PSYCHIATRIC ASSOCIATES
Entity type:Organization
Organization Name:MIZELLE PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:Q
Authorized Official - Last Name:MIZELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-561-7999
Mailing Address - Street 1:3737 GLENWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5515
Mailing Address - Country:US
Mailing Address - Phone:919-561-7999
Mailing Address - Fax:919-400-4395
Practice Address - Street 1:3737 GLENWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5515
Practice Address - Country:US
Practice Address - Phone:919-561-7999
Practice Address - Fax:919-400-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty