Provider Demographics
NPI:1558554147
Name:ZOLLER, DIANA (MFT)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:
Last Name:ZOLLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 18TH ST
Mailing Address - Street 2:PMB 136
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2801
Mailing Address - Country:US
Mailing Address - Phone:415-254-4870
Mailing Address - Fax:
Practice Address - Street 1:1459 18TH ST
Practice Address - Street 2:PMB 136
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2801
Practice Address - Country:US
Practice Address - Phone:415-254-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist