Provider Demographics
NPI:1588197735
Name:ZEST 4 LIFE COUNSELING SVCS., LLC
Entity Type:Organization
Organization Name:ZEST 4 LIFE COUNSELING SVCS., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ZANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CRUZ-PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-419-7810
Mailing Address - Street 1:349 SHOAL CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3168
Mailing Address - Country:US
Mailing Address - Phone:718-419-7810
Mailing Address - Fax:678-288-7935
Practice Address - Street 1:265 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4896
Practice Address - Country:US
Practice Address - Phone:678-650-5510
Practice Address - Fax:678-288-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0058811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty