MEDICARE: MARY S ZIMOMRA LPC, LMFT

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	101YP2500X	Professional Counselor	0701001964	VA
2	106H00000X	Marriage & Family Therapist	0717000883	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780770537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY S ZIMOMRA LPC, LMFT

Provider Business Mailing Address
First Line	:	12007 SUNRISE VALLEY DR STE 300
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3446
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Provider Business Practice Location Address
First Line	:	12007 SUNRISE VALLEY DR STE 300
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3446
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	11/04/2024

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