Provider Demographics
NPI:1063024701
Name:SPELLMAN-ZIMMERMAN, DAVID (RADT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:SPELLMAN-ZIMMERMAN
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BROOKTREE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-1906
Mailing Address - Country:US
Mailing Address - Phone:925-330-7075
Mailing Address - Fax:925-993-7517
Practice Address - Street 1:11540 MARSH CREEK RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-9759
Practice Address - Country:US
Practice Address - Phone:925-672-5700
Practice Address - Fax:925-672-1374
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1376600120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)