Provider Demographics
NPI:1124051370
Name:ZONDERMAN, HARRIET (LCSW)
Entity type:Individual
Prefix:MRS
First Name:HARRIET
Middle Name:
Last Name:ZONDERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BREMO RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2438
Mailing Address - Country:US
Mailing Address - Phone:804-288-8925
Mailing Address - Fax:804-288-8925
Practice Address - Street 1:2006 BREMO RD
Practice Address - Street 2:SUITE 204
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2438
Practice Address - Country:US
Practice Address - Phone:804-288-8925
Practice Address - Fax:804-288-8925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040005291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008956561Medicaid
VA060519OtherANTHEM
VA089883OtherSENTARA
VALUE OPTIONSOther002498
038063000OtherMAGELLAN
VA008956561Medicaid