Healthcare Provider Details

I. General information

NPI: 1609326057
Provider Name (Legal Business Name): ATHENA M ZOGRAFOS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/12/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SUNSET BLVD STE 140
ROCKLIN CA
95765-5482
US

IV. Provider business mailing address

670 PLACERVILLE DR STE 2
PLACERVILLE CA
95667-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-6440
  • Fax:
Mailing address:
  • Phone: 530-644-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT131199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: