Gina Marie Zotz, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C012454 Issued in NC

Practice address

1109 Gum Branch Rd Ste 100
Jacksonville, NC 28540-5742

Phone

(252) 424-4886

NPI assigned

Jul 6, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Gina Marie Dibona Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2024 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reviving Wellness and Mental Health, PLLC

  • Clinical Social Worker
  • Jacksonville, NC
  • NPI 1508613282
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1356862718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 GUM BRANCH RD STE 100",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285405742",
            "telephone_number": "252-424-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 GUM BRANCH RD STE 100",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285405742",
            "telephone_number": "252-424-4886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "418 Cyrus Thompson Dr",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285467708",
            "country_code": "US",
            "telephone_number": "252-424-4886",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZOTZ",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-06",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C012454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GINA",
            "last_name": "DIBONA",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexandra Shae Zapp
• Zaraspeech Company PC
• Dawn Zbikowski, NP
• Bailee Nichole Zincke
• Melanie Zook, M.S., CCC-SLP
• Teddy Zulu, LCSWA; LCAS
• Fernanda R Zuluaga Cruz
• Stephanie Zuniga

• Clinical Social Worker in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.