Provider Demographics
NPI:1013599471
Name:MZG COUNSELING, LLC
Entity type:Organization
Organization Name:MZG COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ZISSMAN
Authorized Official - Last Name:GOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-375-9871
Mailing Address - Street 1:4031 UNIVERSITY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3400
Mailing Address - Country:US
Mailing Address - Phone:703-375-9871
Mailing Address - Fax:
Practice Address - Street 1:4031 UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3400
Practice Address - Country:US
Practice Address - Phone:703-375-9871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty