Provider Demographics
NPI:1730298795
Name:ZAMZOW, CHRISTINE A (MA, LPC, LISAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:ZAMZOW
Suffix:
Gender:F
Credentials:MA, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-2514
Mailing Address - Country:US
Mailing Address - Phone:520-836-1688
Mailing Address - Fax:520-876-1796
Practice Address - Street 1:210 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2514
Practice Address - Country:US
Practice Address - Phone:520-836-1688
Practice Address - Fax:520-876-1796
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10670101YA0400X
AZLPC-11775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11775OtherLPC
AZ10670OtherLISAC
AZ934522Medicaid
80359OtherNCC