Provider Demographics
NPI:1154000511
Name:RUSSELL, ZACHARY FARRINGTON (LCSWA)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:FARRINGTON
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 E BROAD ST STE 127
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1968
Mailing Address - Country:US
Mailing Address - Phone:203-581-0920
Mailing Address - Fax:
Practice Address - Street 1:1903 N HARRISON AVE STE 100
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3003
Practice Address - Country:US
Practice Address - Phone:203-581-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0193761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical