| Lake Norman Psychiatry & Counseling, Pllc | |
|
116 South Main Street Suite 205 Mooresville NC 28115-0900 | |
| (704) 662-3270 | |
| (704) 662-3288 |
| Full Name | Lake Norman Psychiatry & Counseling, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychosomatic Medicine |
| Location | 116 South Main Street Suite 205, Mooresville, North Carolina |
| Authorized Official Name and Position | John Edward Latz (MEMBER MANAGER) |
| Authorized Official Contact | 7046623200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Norman Psychiatry & Counseling, Pllc 116 South Main Street Suite 205 Po Box 900 Mooresville NC 28115-0900 Ph: (704) 662-3270 | Lake Norman Psychiatry & Counseling, Pllc 116 South Main Street Suite 205 Mooresville NC 28115-0900 Ph: (704) 662-3270 |
| NPI Number | 1568674752 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568674752 | NPI | - | NPPES |
| 0276R | Other | NC | BCBS GROUP NUMBER |
| 890276R | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0015X | Psychiatry & Neurology - Psychosomatic Medicine | 35688 (North Carolina) | Primary |
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