Provider Demographics
NPI:1285388801
Name:ALLEN, ZACHARIAS ESAIAS SR (REVEREND)
Entity type:Individual
Prefix:
First Name:ZACHARIAS
Middle Name:ESAIAS
Last Name:ALLEN
Suffix:SR
Gender:M
Credentials:REVEREND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 PROVIDENCE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-1268
Mailing Address - Country:US
Mailing Address - Phone:704-224-0895
Mailing Address - Fax:
Practice Address - Street 1:11530 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8460
Practice Address - Country:US
Practice Address - Phone:980-343-5988
Practice Address - Fax:980-343-5990
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP1600X
NC3298768928390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral