Healthcare Provider Details

I. General information

NPI: 1184211021
Provider Name (Legal Business Name): RAUL ZAMORA-DUPREY MSW, LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: ADVAITA ZAMORA-DUPREY MSW, LCSW

II. Dates (important events)

Enumeration Date: 12/27/2020
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 4TH ST
WILMINGTON NC
28401-3450
US

IV. Provider business mailing address

341 S. COLLEGE RD., STE. 11 PMB 2027
WILMINGTON NC
28403
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0270
  • Fax:
Mailing address:
  • Phone: 336-840-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC016501
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: