Organization
LAKE NORMAN INTEGRATIVE PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY THOMPSON LATZ M.D., M.S. (SOLE OWNER)
(704) 662-3200
Entity
Organization
Contact information
Practice address
116 S MAIN ST STE 301, MOORESVILLE, NC 28115-2373
(704) 662-3200
(704) 662-1247
Mailing address
116 S MAIN ST STE 301, P.O. BOX 1247, MOORESVILLE, NC 28115-2373
(704) 662-3200
(704) 662-8731
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
34660
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407879851
DR LATZ NPI NUMBER
NC
05
—
7951148
—
NC
Enumeration date
05/11/2007
Last updated
10/03/2007
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