Provider Demographics
NPI:1649460890
Name:MIZIC, KELLEY F (LPC)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:F
Last Name:MIZIC
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GOODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207
Mailing Address - Country:US
Mailing Address - Phone:256-689-9968
Mailing Address - Fax:
Practice Address - Street 1:710 WANA AVE
Practice Address - Street 2:
Practice Address - City:WEAVER
Practice Address - State:AL
Practice Address - Zip Code:36277-3440
Practice Address - Country:US
Practice Address - Phone:256-282-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional