Provider Demographics
NPI:1720800782
Name:ZAC LLC
Entity type:Organization
Organization Name:ZAC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAKREDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TU ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-620-1522
Mailing Address - Street 1:1215 NOTTLEY DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7080
Mailing Address - Country:US
Mailing Address - Phone:470-620-1522
Mailing Address - Fax:
Practice Address - Street 1:1561 HIGHWAY 42 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4721
Practice Address - Country:US
Practice Address - Phone:470-620-1522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ZOKHA AUTISM CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty