Healthcare Provider Details

I. General information

NPI: 1033431481
Provider Name (Legal Business Name): SAUNDRIA C. ZOMALT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 NORTHSIDE PKWY NW BLDG 6
ATLANTA GA
30327-3007
US

IV. Provider business mailing address

4200 NORTHSIDE PKWY NW BLDG 6
ATLANTA GA
30327-3007
US

V. Phone/Fax

Practice location:
  • Phone: 562-668-3557
  • Fax:
Mailing address:
  • Phone: 562-668-3557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC1843
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC010974
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: