Provider Demographics
NPI:1932973211
Name:VAN ZANDT, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:VAN ZANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-7206
Mailing Address - Country:US
Mailing Address - Phone:330-559-5557
Mailing Address - Fax:
Practice Address - Street 1:435 S RIDGEWOOD AVE STE 204C-205
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4927
Practice Address - Country:US
Practice Address - Phone:330-559-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health