Provider Demographics
NPI:1235475310
Name:IZZI, MARIE (MA-LLPC)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:IZZI
Suffix:
Gender:F
Credentials:MA-LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30500 VAN DYKE AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2195
Mailing Address - Country:US
Mailing Address - Phone:586-558-6868
Mailing Address - Fax:
Practice Address - Street 1:30500 VAN DYKE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2195
Practice Address - Country:US
Practice Address - Phone:586-558-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor