Provider Demographics
NPI:1922811249
Name:MITCHEM, ZACHARY WADE (PRSS)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:WADE
Last Name:MITCHEM
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 KANAWHA BLVD W
Mailing Address - Street 2:ATTN ZACK MITCHEM
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-2533
Mailing Address - Country:US
Mailing Address - Phone:304-646-9018
Mailing Address - Fax:304-768-7647
Practice Address - Street 1:1514 KANAWHA BLVD W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2533
Practice Address - Country:US
Practice Address - Phone:304-646-9018
Practice Address - Fax:304-768-7647
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25-902SUD175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist