Provider Demographics
NPI:1487337283
Name:FLETCHER, ZENA DIANE (LMFTA)
Entity type:Individual
Prefix:
First Name:ZENA
Middle Name:DIANE
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-6627
Mailing Address - Country:US
Mailing Address - Phone:919-451-1655
Mailing Address - Fax:
Practice Address - Street 1:360 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-6627
Practice Address - Country:US
Practice Address - Phone:919-451-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12531A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist