Provider Demographics
NPI:1811623408
Name:NIZAM, HOUDA (MS, LPC-A)
Entity Type:Individual
Prefix:
First Name:HOUDA
Middle Name:
Last Name:NIZAM
Suffix:
Gender:F
Credentials:MS, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BLACK KNOB CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-1597
Mailing Address - Country:US
Mailing Address - Phone:801-448-5255
Mailing Address - Fax:
Practice Address - Street 1:128 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1800
Practice Address - Country:US
Practice Address - Phone:801-448-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health