Provider Demographics
NPI:1386903532
Name:ZYWICIEL, JAMIN (ASW)
Entity type:Individual
Prefix:
First Name:JAMIN
Middle Name:
Last Name:ZYWICIEL
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4808
Mailing Address - Country:US
Mailing Address - Phone:530-251-8108
Mailing Address - Fax:530-251-8493
Practice Address - Street 1:555 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130
Practice Address - Country:US
Practice Address - Phone:530-251-8108
Practice Address - Fax:530-251-8493
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health