Healthcare Provider Details

I. General information

NPI: 1265435374
Provider Name (Legal Business Name): CHRISTINA M ZIMMERMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 EBENEZER RD SUITE 215
ROCK HILL SC
29732-4103
US

IV. Provider business mailing address

4217 IVYWOOD DR
ROCK HILL SC
29732-9583
US

V. Phone/Fax

Practice location:
  • Phone: 803-487-3065
  • Fax:
Mailing address:
  • Phone: 803-487-3065
  • Fax: 803-981-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2600
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: