Provider Demographics
NPI:1467934794
Name:ZAMBRANO, RAUL ANTONIO III (LCMHC-A)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:ANTONIO
Last Name:ZAMBRANO
Suffix:III
Gender:M
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25075 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8323
Mailing Address - Country:US
Mailing Address - Phone:386-299-7950
Mailing Address - Fax:
Practice Address - Street 1:7940 WILLIAMS POND LN STE 250
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8412
Practice Address - Country:US
Practice Address - Phone:704-341-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health