Provider Demographics
NPI:1861433591
Name:ZUCK, GRETA ANN (MS)
Entity type:Individual
Prefix:MS
First Name:GRETA
Middle Name:ANN
Last Name:ZUCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CASH ST
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1301
Mailing Address - Country:US
Mailing Address - Phone:919-303-7552
Mailing Address - Fax:919-784-0250
Practice Address - Street 1:3725 NATIONAL DR
Practice Address - Street 2:114
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4066
Practice Address - Country:US
Practice Address - Phone:919-784-0205
Practice Address - Fax:919-784-0250
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102596Medicaid