Provider Demographics
NPI:1578181608
Name:CHAMPION, ZACHARY J (LCSWA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:J
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:CROSSNORE
Mailing Address - State:NC
Mailing Address - Zip Code:28616
Mailing Address - Country:US
Mailing Address - Phone:828-733-4305
Mailing Address - Fax:
Practice Address - Street 1:100 DAR DRIVE
Practice Address - Street 2:
Practice Address - City:CROSSNORE
Practice Address - State:NC
Practice Address - Zip Code:28616-2861
Practice Address - Country:US
Practice Address - Phone:828-733-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0145781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical