Provider Demographics
NPI:1295003713
Name:MAZZOCCHI, EUGENE MIKE (LPC)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:MIKE
Last Name:MAZZOCCHI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1499
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-1499
Mailing Address - Country:US
Mailing Address - Phone:304-688-9732
Mailing Address - Fax:304-855-5544
Practice Address - Street 1:76 FERRELL LAWSON ST
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-4535
Practice Address - Country:US
Practice Address - Phone:304-688-9732
Practice Address - Fax:304-855-5544
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2025101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor