Healthcare Provider Details

I. General information

NPI: 1982817821
Provider Name (Legal Business Name): KRISTIN ZAGAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9358 MAIN ST 2ND FLOOR
MANASSAS VA
20110-5499
US

IV. Provider business mailing address

9358 MAIN ST 2ND FLOOR
MANASSAS VA
20110-5499
US

V. Phone/Fax

Practice location:
  • Phone: 703-887-9707
  • Fax: 703-464-0452
Mailing address:
  • Phone: 703-887-9707
  • Fax: 703-464-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006529
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: