Healthcare Provider Details

I. General information

NPI: 1790963049
Provider Name (Legal Business Name): TARA GATTIS ZOLLICOFFER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRENNER AVE
SALISBURY NC
28144-2515
US

IV. Provider business mailing address

1265 SOOTHING CT NW
CONCORD NC
28027-4324
US

V. Phone/Fax

Practice location:
  • Phone: 704-638-9000
  • Fax:
Mailing address:
  • Phone: 410-952-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005881
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: