Provider Demographics
NPI:1194102509
Name:ZACHARY, CORLOTTA
Entity type:Individual
Prefix:
First Name:CORLOTTA
Middle Name:
Last Name:ZACHARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 LAKE RD
Mailing Address - Street 2:STE. D
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5756
Mailing Address - Country:US
Mailing Address - Phone:936-222-9536
Mailing Address - Fax:281-936-0260
Practice Address - Street 1:98 WILLOWBEND ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-3031
Practice Address - Country:US
Practice Address - Phone:936-222-9526
Practice Address - Fax:281-936-0260
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker