Provider Demographics
NPI:1992342067
Name:ZEIGLER UGALDE, CORTNEY
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:ZEIGLER UGALDE
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 1:1406 SANDBAG TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2577
Mailing Address - Country:US
Mailing Address - Phone:716-801-5321
Mailing Address - Fax:
Practice Address - Street 1:9023 FOREST HILL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3054
Practice Address - Country:US
Practice Address - Phone:804-638-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-07
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional