Provider Demographics
NPI:1063475739
Name:ZODA, MICHAEL FRANCIS (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:ZODA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 KILLEARN CENTER BLVD
Mailing Address - Street 2:SUITE C2
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3467
Mailing Address - Country:US
Mailing Address - Phone:850-668-2959
Mailing Address - Fax:850-894-9957
Practice Address - Street 1:1535 KILLEARN CENTER BLVD
Practice Address - Street 2:SUITE C2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3467
Practice Address - Country:US
Practice Address - Phone:850-668-2959
Practice Address - Fax:850-894-9957
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist