Healthcare Provider Details

I. General information

NPI: 1154000511
Provider Name (Legal Business Name): ZACHARY FARRINGTON RUSSELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 N HARRISON AVE STE 100
CARY NC
27513-3003
US

IV. Provider business mailing address

1441 E BROAD ST STE 127
FUQUAY VARINA NC
27526-1968
US

V. Phone/Fax

Practice location:
  • Phone: 203-581-0920
  • Fax:
Mailing address:
  • Phone: 203-581-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019232
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: