Provider Demographics
NPI:1811517683
Name:ZAMORA, TARA (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 SPEIGHT LYONS LOOP
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7413
Mailing Address - Country:US
Mailing Address - Phone:757-751-5151
Mailing Address - Fax:
Practice Address - Street 1:2107 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-3527
Practice Address - Country:US
Practice Address - Phone:757-494-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813001067103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool