Provider Demographics
NPI:1467850248
Name:BAHTA, ZEBIB
Entity Type:Individual
Prefix:
First Name:ZEBIB
Middle Name:
Last Name:BAHTA
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 1:705 LEAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4224
Mailing Address - Country:US
Mailing Address - Phone:571-232-8458
Mailing Address - Fax:
Practice Address - Street 1:119 WEST AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-4332
Practice Address - Country:US
Practice Address - Phone:704-630-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA11156OtherNORTH CAROLINA BOARD OF LICENSED PROFESSIONAL COUNSELORS