Individual
SHANNON COURTNEY LUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPA
Contact information
Practice address
1515 MOCKINGBIRD LN, SUITE 515, CHARLOTTE, NC 28209-3236
(704) 999-4191
(980) 949-8180
Mailing address
1515 MOCKINGBIRD LN, SUITE 515, CHARLOTTE, NC 28209-3236
(704) 999-4191
(980) 949-8180
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2532
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6107208
—
NC
Enumeration date
09/16/2006
Last updated
01/11/2013
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