Provider Demographics
NPI:1609634682
Name:SOSA, ZACHARY C (CADC)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:C
Last Name:SOSA
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 BOSTON WAY APT 4
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-3123
Mailing Address - Country:US
Mailing Address - Phone:309-271-9966
Mailing Address - Fax:
Practice Address - Street 1:430 SOUTHGATE AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4425
Practice Address - Country:US
Practice Address - Phone:319-351-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)