Healthcare Provider Details

I. General information

NPI: 1902824568
Provider Name (Legal Business Name): DEBORAH S ZOLLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBBIE SIEGEL

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 W CORNWALLIS RD
DURHAM NC
27705-5707
US

IV. Provider business mailing address

1937 W CORNWALLIS RD
DURHAM NC
27705-5707
US

V. Phone/Fax

Practice location:
  • Phone: 919-354-4922
  • Fax: 919-354-4960
Mailing address:
  • Phone: 919-354-4922
  • Fax: 919-354-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005076
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: