Provider Demographics
NPI:1710382015
Name:ZAJAROS, THERESE (MA)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:ZAJAROS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 MASTERS ST
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-9039
Mailing Address - Country:US
Mailing Address - Phone:313-268-4279
Mailing Address - Fax:810-232-7599
Practice Address - Street 1:420 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2445
Practice Address - Country:US
Practice Address - Phone:810-257-3700
Practice Address - Fax:810-496-5735
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical