Provider Demographics
NPI:1922347814
Name:ZEDIKER, KACIE MICHELLE (LPC, ATR, CSOTP)
Entity Type:Individual
Prefix:MRS
First Name:KACIE
Middle Name:MICHELLE
Last Name:ZEDIKER
Suffix:
Gender:F
Credentials:LPC, ATR, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 FOX CREEK CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7138
Mailing Address - Country:US
Mailing Address - Phone:571-212-4878
Mailing Address - Fax:
Practice Address - Street 1:7460 CENTRAL BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2818
Practice Address - Country:US
Practice Address - Phone:757-644-6391
Practice Address - Fax:757-622-2011
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health