Provider Demographics
NPI:1063652865
Name:ZAVALA, CAROLINE MARIE (MA, LPC, IMH-E(II))
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:MARIE
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:MA, LPC, IMH-E(II)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1582
Mailing Address - Country:US
Mailing Address - Phone:313-757-2279
Mailing Address - Fax:
Practice Address - Street 1:227 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1582
Practice Address - Country:US
Practice Address - Phone:313-757-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009524101YP2500X
MI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional