Provider Demographics
NPI:1194862847
Name:ZACKRISON, DOLCELYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DOLCELYN
Middle Name:
Last Name:ZACKRISON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HIDDEN TRACE DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2729
Mailing Address - Country:US
Mailing Address - Phone:706-935-4700
Mailing Address - Fax:706-935-4748
Practice Address - Street 1:30 HIDDEN TRACE DR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2729
Practice Address - Country:US
Practice Address - Phone:706-935-4700
Practice Address - Fax:706-935-4748
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical