Individual
AUTUMN KAYLEN MIZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC-A
Contact information
Practice address
1314 ECOLA VALLEY CT, WAKE FOREST, NC 27587-4915
(984) 212-2757
Mailing address
1314 ECOLA VALLEY CT, WAKE FOREST, NC 27587-4915
(984) 212-2757
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A19989
NC
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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