Healthcare Provider Details

I. General information

NPI: 1962988683
Provider Name (Legal Business Name): JAMOKI ZAKIA DANTZLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N FRIO ST BLDG 1
SAN ANTONIO TX
78207-3011
US

IV. Provider business mailing address

5503 GRISSOM RD STE 156
SAN ANTONIO TX
78238-3036
US

V. Phone/Fax

Practice location:
  • Phone: 210-246-1300
  • Fax:
Mailing address:
  • Phone: 210-680-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70096
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70096
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: