Provider Demographics
NPI:1558805853
Name:ZIDARICH, DINKO MICHAEL (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:DINKO
Middle Name:MICHAEL
Last Name:ZIDARICH
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2457
Mailing Address - Country:US
Mailing Address - Phone:424-226-2554
Mailing Address - Fax:
Practice Address - Street 1:6311 ROMAINE ST STE 7329
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038
Practice Address - Country:US
Practice Address - Phone:424-226-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist