1780899583 NPI number — SUZE MARIE MAZE LCSW, CCGC, CEAP

Table of content: SUZE MARIE MAZE LCSW, CCGC, CEAP (NPI 1780899583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780899583 NPI number — SUZE MARIE MAZE LCSW, CCGC, CEAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAZE
Provider First Name:
SUZE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CCGC, CEAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780899583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2456 EDGEFIELD HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29801-8018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-646-1487
Provider Business Mailing Address Fax Number:
803-646-1487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2331 FORTUNE DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-421-5831
Provider Business Practice Location Address Fax Number:
859-402-8084
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  9615 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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