Provider Demographics
NPI:1144254319
Name:ZUCCOLO, MARK R (MA, PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:ZUCCOLO
Suffix:
Gender:M
Credentials:MA, PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 N POINT PKWY
Mailing Address - Street 2:SUITE 33
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1142
Mailing Address - Country:US
Mailing Address - Phone:678-554-5632
Mailing Address - Fax:770-645-2588
Practice Address - Street 1:5755 N POINT PKWY
Practice Address - Street 2:SUITE 33
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1142
Practice Address - Country:US
Practice Address - Phone:678-554-5632
Practice Address - Fax:770-645-2588
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001161106H00000X
CAIMF50711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist