Provider Demographics
NPI:1235401092
Name:ZIMMERMAN, VIRGINIA (PHD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 WINESAP WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7182
Mailing Address - Country:US
Mailing Address - Phone:301-836-1071
Mailing Address - Fax:
Practice Address - Street 1:8894 STANFORD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5161
Practice Address - Country:US
Practice Address - Phone:301-836-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDO4960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical