Provider Demographics
NPI:1134164536
Name:ZABACK, CHARLOTTE PEARL X (PHD LPC)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:PEARL
Last Name:ZABACK
Suffix:X
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2435
Mailing Address - Country:US
Mailing Address - Phone:302-736-1350
Mailing Address - Fax:
Practice Address - Street 1:148 S BRADFORD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7318
Practice Address - Country:US
Practice Address - Phone:302-736-1820
Practice Address - Fax:302-736-5016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000882067Medicaid