Provider Demographics
NPI:1407171523
Name:DELOZIA, MILDRED LOIS (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:MILDRED
Middle Name:LOIS
Last Name:DELOZIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E BELT LINE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5758
Mailing Address - Country:US
Mailing Address - Phone:214-970-3559
Mailing Address - Fax:
Practice Address - Street 1:229 E BELT LINE RD STE 301
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5758
Practice Address - Country:US
Practice Address - Phone:214-970-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX043211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S17NMedicare PIN