Provider Demographics
NPI:1881035012
Name:ZAJDEL, TRACI NACOLE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:NACOLE
Last Name:ZAJDEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:NACOLE
Other - Last Name:FERRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1709 GORNTO RD. STE. A #311
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601
Mailing Address - Country:US
Mailing Address - Phone:850-459-1757
Mailing Address - Fax:
Practice Address - Street 1:101 NORTHSIDE DRIVE
Practice Address - Street 2:BUILDING F
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602
Practice Address - Country:US
Practice Address - Phone:229-474-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
GAMFT001181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator