Provider Demographics
NPI:1639535826
Name:MISZ, JON-ERIK (MDIV, LCSWA)
Entity Type:Individual
Prefix:
First Name:JON-ERIK
Middle Name:
Last Name:MISZ
Suffix:
Gender:M
Credentials:MDIV, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1097
Mailing Address - Country:US
Mailing Address - Phone:336-716-0653
Mailing Address - Fax:336-238-4152
Practice Address - Street 1:403 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1097
Practice Address - Country:US
Practice Address - Phone:336-716-0855
Practice Address - Fax:336-238-4152
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0101761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical