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General NPI Number Information
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NPI Number | 1083157085
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Entity Type | Individual
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Provider Name | ZACHARY CHARLES TALBOTT MSW, LMSW, LADAC, MAC, CAADC, CCS
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Gender | Male
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 1821 W Broadway Ave
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City | Maryville
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State | TN
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Zip | 37801
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Country | US
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Telephone | 8657240852
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Fax | 8657240853
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Provider Business Mailing Address
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Address Line | 1821 W Broadway Ave
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City | Maryville
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State | Tennessee
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Zip | 37801
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Country | US
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Telephone | 8657240852
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Fax | 8657240853
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | 101YA0400X
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License Number | 1413
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License Number State | Tennessee
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Taxonomy #2
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Taxonomy Code |
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Taxonomy Name | 104100000X
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License Number | 12713
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License Number State | Tennessee
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Taxonomy #3
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Taxonomy Code |
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Taxonomy Name | 101YA0400X
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License Number | C0312
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License Number State | Georgia
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