MEDICARE: ZACH HOLZMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC010899	GA
2	101YP2500X	Professional Counselor	LPC010899	GA
3	101YM0800X	Mental Health Counselor	LPC010899	GA

General Provider Information

NPI Number	:	1700432317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACH HOLZMAN

Provider Business Mailing Address
First Line	:	550 NORTHRIDGE PKWY APT 2110
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-3374
Country	:	US
Telephone Number	:	404-326-4946
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 NORTHRIDGE PKWY APT 2110
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-3374
Country	:	US
Telephone Number	:	404-326-4946
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2019
Last Update Date	:	08/11/2019

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Directions to “ ZACH HOLZMAN ” Practice Location

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