Healthcare Provider Details

I. General information

NPI: 1861433591
Provider Name (Legal Business Name): GRETA ANN ZUCK M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 NATIONAL DR 114
RALEIGH NC
27612-4066
US

IV. Provider business mailing address

705 CASH ST
APEX NC
27502-1301
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-0205
  • Fax: 919-784-0250
Mailing address:
  • Phone: 919-303-7552
  • Fax: 919-784-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3868
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: