Provider Demographics
NPI:1831347335
Name:CHRISTIE-MIZELL, CHARLES ANDRE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES ANDRE
Middle Name:
Last Name:CHRISTIE-MIZELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7110
Mailing Address - Country:US
Mailing Address - Phone:330-672-3776
Mailing Address - Fax:
Practice Address - Street 1:1350 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7110
Practice Address - Country:US
Practice Address - Phone:330-672-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5687103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist