Provider Demographics
NPI:1295758985
Name:ZUCKERMAN, KIM L (LMHC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 HICKORY WOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3560
Mailing Address - Country:US
Mailing Address - Phone:561-252-4097
Mailing Address - Fax:
Practice Address - Street 1:1679 HICKORY WOOD CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3560
Practice Address - Country:US
Practice Address - Phone:561-252-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7201101YM0800X
GALPC005527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764235100Medicaid