Provider Demographics
NPI:1336801042
Name:KNOWLES, ZACHARY THOMAS (MSW, LCAS)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:THOMAS
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:MSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 BRASSFIELD RD APT 5302
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9454
Mailing Address - Country:US
Mailing Address - Phone:919-703-5668
Mailing Address - Fax:
Practice Address - Street 1:3710 UNIVERSITY DR STE 120
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6204
Practice Address - Country:US
Practice Address - Phone:919-906-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27528101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)