Healthcare Provider Details

I. General information

NPI: 1841942158
Provider Name (Legal Business Name): ASHLEE ZITO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 PEACHTREE RD., SUITE A, #648
BROOKHAVEN GA
30319
US

IV. Provider business mailing address

4062 PEACHTREE RD., SUITE A, #648
BROOKHAVEN GA
30319
US

V. Phone/Fax

Practice location:
  • Phone: 470-670-6200
  • Fax: 470-670-6300
Mailing address:
  • Phone: 470-670-6200
  • Fax: 470-670-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY004103
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: