Provider Demographics
NPI:1902824568
Name:ZOLLER, DEBORAH S (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:ZOLLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1937 W CORNWALLIS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5707
Mailing Address - Country:US
Mailing Address - Phone:919-354-4922
Mailing Address - Fax:919-354-4960
Practice Address - Street 1:1937 W CORNWALLIS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5707
Practice Address - Country:US
Practice Address - Phone:919-354-4922
Practice Address - Fax:919-354-4960
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0050761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106538Medicaid
NC1400VOtherBCBS