Provider Demographics
NPI:1851466296
Name:ZANDONA, HOLLI JO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HOLLI
Middle Name:JO
Last Name:ZANDONA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9712 FAIR OAKS BLVD STE A-1
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7032
Mailing Address - Country:US
Mailing Address - Phone:279-321-1555
Mailing Address - Fax:
Practice Address - Street 1:9712 FAIR OAKS BLVD STE A1
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7032
Practice Address - Country:US
Practice Address - Phone:279-321-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical