Provider Demographics
NPI:1992184808
Name:MIZELL, KELSEY (LPC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:
Last Name:MIZELL
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:GERSHENHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:120 EAST TRINITY PLACE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30030
Mailing Address - Country:US
Mailing Address - Phone:404-378-2300
Mailing Address - Fax:
Practice Address - Street 1:120 E TRINITY PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3302
Practice Address - Country:US
Practice Address - Phone:404-378-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004685101YM0800X
GALPC009997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health