Individual
MR. WILLIAM ASHLEY MIZELLE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS,LCMHC,CCS
Contact information
Practice address
2602 COURTIER DR, GREENVILLE, NC 27834-7818
(252) 752-0483
(252) 757-3172
Mailing address
1492 TULL RD, GREENVILLE, NC 27858-8366
(252) 814-5441
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6860
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
10014
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1061
NC
101YM0800X
Mental Health Counselor
6860
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143KY
BCBS
NC
01
—
191488
MEDCOST
NC
05
—
6111889
—
NC
Enumeration date
11/28/2006
Last updated
10/23/2023
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