Provider Demographics
NPI:1710490271
Name:WOLLACK, ZACHARY PAUL (LMSW)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:PAUL
Last Name:WOLLACK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43902 WOODWARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5021
Mailing Address - Country:US
Mailing Address - Phone:888-622-3345
Mailing Address - Fax:248-516-0068
Practice Address - Street 1:43902 WOODWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5021
Practice Address - Country:US
Practice Address - Phone:248-724-2643
Practice Address - Fax:248-516-0068
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010923071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical