Provider Demographics
NPI:1134473051
Name:ZALIS, ANNELLEN (LADC)
Entity Type:Individual
Prefix:
First Name:ANNELLEN
Middle Name:
Last Name:ZALIS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5133
Mailing Address - Country:US
Mailing Address - Phone:508-224-7701
Mailing Address - Fax:508-224-2175
Practice Address - Street 1:1233 STATE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5133
Practice Address - Country:US
Practice Address - Phone:508-224-7701
Practice Address - Fax:508-224-2175
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA597181020101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)