Healthcare Provider Details

I. General information

NPI: 1790458529
Provider Name (Legal Business Name): RANDY GARCIA ZAVALA LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RANDY GARCIA LCMHC

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N GREENE ST
GREENSBORO NC
27401-2024
US

IV. Provider business mailing address

8101 GREEN LANTERN ST APT 204
RALEIGH NC
27613-4560
US

V. Phone/Fax

Practice location:
  • Phone: 336-604-5100
  • Fax:
Mailing address:
  • Phone: 984-259-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16763
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: