Provider Demographics
NPI:1447919170
Name:ZAKARIAH, MARIAM
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:ZAKARIAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 WOODFALL LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8412
Mailing Address - Country:US
Mailing Address - Phone:209-614-7128
Mailing Address - Fax:
Practice Address - Street 1:4101 WOODFALL LN
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8412
Practice Address - Country:US
Practice Address - Phone:209-614-7128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor