Wallen, Mitzi D.
Wallen, Mitzi D. is an sole proprietor health care provider with primary practice located at 105 Central Ave Unit 4 , Goose Creek SC 29445. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Wallen, Mitzi D. can be contacted via phone (310) 874-0166.Contact Information
Primary practice address
105 Central Ave Unit 4
Goose Creek SC 29445
Phone: (310) 874-0166
Fax: (843) 761-7308
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | ||
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 5771 | South Carolina |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 5771 | South Carolina |
Profile Details
| NPI number | 1629330667 |
|---|---|
| LBN Legal business name | Wallen, Mitzi D. |
| Credentials | Licensed Professional Counselor (LPC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 14th, 2012 |
| Last updated | Dec 23rd, 2024 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629330667 | NPPES |
| Massachusetts | Other | MA COUNSELOR | BH SOCIAL SERVICE |
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