Provider Demographics
NPI:1760548473
Name:ZIZA, NICK
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:ZIZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 FAR HILLS AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1687
Mailing Address - Country:US
Mailing Address - Phone:937-296-0607
Mailing Address - Fax:
Practice Address - Street 1:2600 FAR HILLS AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1687
Practice Address - Country:US
Practice Address - Phone:937-296-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health