Healthcare Provider Details

I. General information

NPI: 1437700176
Provider Name (Legal Business Name): JOSHUA VINCENT ZUMMO LPCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CLANTON RD
CHARLOTTE NC
28217-1309
US

IV. Provider business mailing address

515 CLANTON RD
CHARLOTTE NC
28217-1309
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-9001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA15187
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: