Provider Demographics
NPI:1811234198
Name:COUNCIL, ZELDA J (MS RD LN)
Entity Type:Individual
Prefix:
First Name:ZELDA
Middle Name:J
Last Name:COUNCIL
Suffix:
Gender:F
Credentials:MS RD LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 HUFFMAN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2960
Mailing Address - Country:US
Mailing Address - Phone:803-467-1281
Mailing Address - Fax:
Practice Address - Street 1:2127 HUFFMAN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2960
Practice Address - Country:US
Practice Address - Phone:803-467-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC750133V00000X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic