Provider Demographics
NPI:1891032900
Name:FLETCHER, ZACHARY WAYNE (PC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:WAYNE
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 W MARKET ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3617
Mailing Address - Country:US
Mailing Address - Phone:330-983-9310
Mailing Address - Fax:
Practice Address - Street 1:3094 W MARKET ST STE 105
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3617
Practice Address - Country:US
Practice Address - Phone:330-983-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200533101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor