Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1488 | CT |
Y | 103TC0700X | Clinical Psychologist | 1488 | CT |
N | 102L00000X | Psychologist | 1488 | CT |
N | 103T00000X | Psychologist | 1488 | CT |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1488 | CT |
N | 103TA0700X | Adult Development & Aging Psychologist | 1488 | CT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1488 | CT |
N | 103G00000X | Clinical Psychologist | 1488 | CT |
N | 103TC0700X | Clinical Psychologist | 1488 | CT |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1488 | CT |
N | 103TF0000X | Family Psychologist | 1488 | CT |
N | 103TF0200X | Forensic Psychologist | 1488 | CT |
N | 103TH0004X | Health Psychologist | 1488 | CT |
N | 103TH0100X | Health Service | 1488 | CT |
N | 103TM1800X | Intellectual & Developmental Disabilities | 1488 | CT |
N | 103TP2701X | Group Psychotherapist | 1488 | CT |
N | 103TR0400X | Rehabilitation Psychologist | 1488 | CT |
N | 103TS0200X | School Psychologist | 1488 | CT |
NPI | 1427234491 |
---|---|
Provider Name | Dr. Marc Zola |
First Address | Clarksville, TN 37043-9305 |
Second Address | Fort Campbell, KY 42223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 22/03/2019 |