Provider Demographics
NPI:1154497220
Name:MIZELLE, WILLIAM ASHLEY JR (LCAS,LCMHC,CCS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ASHLEY
Last Name:MIZELLE
Suffix:JR
Gender:M
Credentials:LCAS,LCMHC,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 TULL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8366
Mailing Address - Country:US
Mailing Address - Phone:252-814-5441
Mailing Address - Fax:
Practice Address - Street 1:2602 COURTIER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7818
Practice Address - Country:US
Practice Address - Phone:252-752-0483
Practice Address - Fax:252-757-3172
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6860101Y00000X, 101YM0800X
NC10014101YA0400X
NC1061101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111889Medicaid
NC191488OtherMEDCOST
NC143KYOtherBCBS