Provider Demographics
NPI:1497812804
Name:ZORN, ALICIA RUTH (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:RUTH
Last Name:ZORN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:RUTH
Other - Last Name:COGDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:228 LAZY RIVER LANE
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461
Mailing Address - Country:US
Mailing Address - Phone:843-609-8685
Mailing Address - Fax:843-761-3025
Practice Address - Street 1:105 CENTRAL AVE UNIT 18
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3278
Practice Address - Country:US
Practice Address - Phone:843-588-5710
Practice Address - Fax:843-429-8998
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8588104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker