Healthcare Provider Details

I. General information

NPI: 1376371559
Provider Name (Legal Business Name): CHRISTOPHER JOHN ZDUNOWSKI CSAC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20500 WARRIORS WAY
MILFORD VA
22514-2867
US

IV. Provider business mailing address

20500 WARRIORS WAY
MILFORD VA
22514-2867
US

V. Phone/Fax

Practice location:
  • Phone: 804-529-3473
  • Fax:
Mailing address:
  • Phone: 804-529-3473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709025541
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: