Provider Demographics
NPI:1740553171
Name:PICKLESIMER, ZOYA (LCAS, LPC)
Entity type:Individual
Prefix:
First Name:ZOYA
Middle Name:
Last Name:PICKLESIMER
Suffix:
Gender:F
Credentials:LCAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 CEDAR AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4423
Mailing Address - Country:US
Mailing Address - Phone:910-685-6928
Mailing Address - Fax:910-401-1810
Practice Address - Street 1:4620 CEDAR AVE STE 117
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4423
Practice Address - Country:US
Practice Address - Phone:910-685-6928
Practice Address - Fax:910-401-1810
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
NC8718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)