Provider Demographics
NPI:1770234320
Name:MIZE, BROOKE SMITH (MA, NCC, LCMHCA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:SMITH
Last Name:MIZE
Suffix:
Gender:F
Credentials:MA, NCC, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 NC HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-8882
Mailing Address - Country:US
Mailing Address - Phone:336-342-5756
Mailing Address - Fax:336-349-1115
Practice Address - Street 1:405 NC HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-8882
Practice Address - Country:US
Practice Address - Phone:336-342-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health