Provider Demographics
NPI:1063557817
Name:ZICCHINO, CARRIE ANNE (MHS, CRC)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANNE
Last Name:ZICCHINO
Suffix:
Gender:F
Credentials:MHS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 REDWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-6102
Mailing Address - Country:US
Mailing Address - Phone:352-680-1018
Mailing Address - Fax:
Practice Address - Street 1:1601 NE 25TH AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8800
Practice Address - Country:US
Practice Address - Phone:352-671-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 4963101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor