Basic Information
| Provider Information | |||||||||
| NPI: | 1679699979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | GERALDINE | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14930 STONEY BROOK DR | ||||||||
| Address2: | |||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483155574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866270024 | ||||||||
| FaxNumber: | 5866270027 | ||||||||
| Practice Location | |||||||||
| Address1: | 279 N GROESBECK HWY | ||||||||
| Address2: | |||||||||
| City: | MOUNT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480431546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866270024 | ||||||||
| FaxNumber: | 5866270027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401006535 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.