Provider Demographics
NPI:1356862718
Name:ZOTZ, GINA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:ZOTZ
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:DIBONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1109 GUM BRANCH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5742
Mailing Address - Country:US
Mailing Address - Phone:252-424-4886
Mailing Address - Fax:
Practice Address - Street 1:1109 GUM BRANCH RD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5742
Practice Address - Country:US
Practice Address - Phone:252-424-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0124541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical