Healthcare Provider Details

I. General information

NPI: 1881035012
Provider Name (Legal Business Name): TRACI NACOLE ZAJDEL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACI NACOLE FERRIS LMFT

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NORTHSIDE DRIVE BUILDING F
VALDOSTA GA
31602
US

IV. Provider business mailing address

1709 GORNTO RD. STE. A #311
VALDOSTA GA
31601
US

V. Phone/Fax

Practice location:
  • Phone: 229-474-9800
  • Fax:
Mailing address:
  • Phone: 850-459-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001181
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: