Healthcare Provider Details

I. General information

NPI: 1326532946
Provider Name (Legal Business Name): AMELIA ZAKOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CHURCH ST NW STE 205
VIENNA VA
22180-4550
US

IV. Provider business mailing address

144 CHURCH ST NW STE 205
VIENNA VA
22180-4550
US

V. Phone/Fax

Practice location:
  • Phone: 703-622-8378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: