Active NPI
Mary Grace Virginia Mzyk, LMFT
- Marriage & Family Therapist
- Raleigh, NC
National Provider Identifier
1114213352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1383
- Practice address
- 8522 Six Forks Rd
Suite 103
Raleigh, NC 27615 - Phone
- (866) 314-2366
- NPI assigned
- Jun 27, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1383 | NC | Primary |
Addresses
Primary practice location
8522 Six Forks Rd
Suite 103
Raleigh, NC 27615
Mailing address
8522 Six Forks Rd Ste 103
Raleigh, NC 27615-3098
Phone (919) 621-3468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 7, 2025 through Jan 7, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1383 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642377600000",
"number": "1114213352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8522 SIX FORKS RD STE 103",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276153098",
"telephone_number": "919-621-3468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8522 SIX FORKS RD",
"address_2": "SUITE 103",
"city": "RALEIGH",
"state": "NC",
"postal_code": "27615",
"telephone_number": "866-314-2366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MZYK",
"first_name": "MARY GRACE",
"middle_name": "VIRGINIA",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-27",
"last_updated": "2022-01-17",
"certification_date": "2022-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NC",
"license": "1383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.