Most Relevant Information
Provider Data
| NPI Number: | 1003532052 |
| Provider Name: | MAZIE ELLIS LCSWA |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | LCAS-28501 |
Most Important Dates
| Enumeration Date: | 10/12/2022 |
| Last Updated: | 10/30/2023 |
Provider Practice Location
3605 CAMSON RD
FAYETTEVILLE
NC
283063743
Practice Location Phone/Fax
| Phone: | 9103914520 |
| Fax: |
Provider Mailing Location
3605 CAMSON RD
FAYETTEVILLE
NC
283063743
Provider Mailing Phone/Fax
| Phone: | 9103914520 |
| Fax: |