Provider Demographics
NPI:1558946624
Name:KOJIMA, MIZUKI (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MIZUKI
Middle Name:
Last Name:KOJIMA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WISCONSIN AVENUE NW
Mailing Address - Street 2:# 850
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:202-415-8197
Mailing Address - Fax:
Practice Address - Street 1:2500 WISCONSIN AVENUE NW
Practice Address - Street 2:# 850
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-415-8197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500827621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical