Healthcare Provider Details

I. General information

NPI: 1285388801
Provider Name (Legal Business Name): ZACHARIAS ESAIAS ALLEN SR. REVEREND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11530 BEATTIES FORD RD
HUNTERSVILLE NC
28078-8460
US

IV. Provider business mailing address

2415 PROVIDENCE CHURCH RD
SALISBURY NC
28146-1268
US

V. Phone/Fax

Practice location:
  • Phone: 980-343-5988
  • Fax: 980-343-5990
Mailing address:
  • Phone: 704-224-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3298768928
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: