Provider Demographics
NPI:1265528152
Name:NASH, ZYNOVIA B (MA, LPA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:ZYNOVIA
Middle Name:B
Last Name:NASH
Suffix:
Gender:F
Credentials:MA, LPA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4535
Mailing Address - Country:US
Mailing Address - Phone:910-484-0966
Mailing Address - Fax:
Practice Address - Street 1:711 EXECUTIVE PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5193
Practice Address - Country:US
Practice Address - Phone:910-323-2311
Practice Address - Fax:910-678-9963
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC467103TC0700X
NC444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107377Medicaid