Healthcare Provider Details

I. General information

NPI: 1356862718
Provider Name (Legal Business Name): GINA MARIE ZOTZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA MARIE DIBONA

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 GUM BRANCH RD STE 100
JACKSONVILLE NC
28540-5742
US

IV. Provider business mailing address

1109 GUM BRANCH RD STE 100
JACKSONVILLE NC
28540-5742
US

V. Phone/Fax

Practice location:
  • Phone: 252-424-4886
  • Fax:
Mailing address:
  • Phone: 252-424-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012454
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: