Healthcare Provider Details

I. General information

NPI: 1063557817
Provider Name (Legal Business Name): CARRIE ANNE ZICCHINO MHS, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NE 25TH AVE SUITE 306
OCALA FL
34470-8800
US

IV. Provider business mailing address

35 REDWOOD TRCE
OCALA FL
34472-6102
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-7884
  • Fax:
Mailing address:
  • Phone: 352-680-1018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberIMH 4963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: