Healthcare Provider Details

I. General information

NPI: 1588286538
Provider Name (Legal Business Name): ALICE TERESA ZIC MPH, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 07/11/2023
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 MIDDLETOWN RD UNIT A
COLCHESTER CT
06415-2307
US

IV. Provider business mailing address

3611 CHAIN BRIDGE RD STE C
FAIRFAX VA
22030-3246
US

V. Phone/Fax

Practice location:
  • Phone: 203-800-9011
  • Fax:
Mailing address:
  • Phone: 703-634-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: