Provider Demographics
NPI:1215372107
Name:MITZNER, BLANCH BILLIE (NCC, CACI)
Entity Type:Individual
Prefix:
First Name:BLANCH
Middle Name:BILLIE
Last Name:MITZNER
Suffix:
Gender:F
Credentials:NCC, CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N NASH ST
Mailing Address - Street 2:#848
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3616
Mailing Address - Country:US
Mailing Address - Phone:703-522-8832
Mailing Address - Fax:
Practice Address - Street 1:1800 R ST NW
Practice Address - Street 2:C-4
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1625
Practice Address - Country:US
Practice Address - Phone:202-417-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACI1000101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)