Organization
LAKE NORMAN PSYCHIATRY & COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN EDWARD LATZ JR. M.D. (MEMBER MANAGER)
(704) 662-3200
Entity
Organization
Contact information
Practice address
116 SOUTH MAIN STREET SUITE 205, MOORESVILLE, NC 28115-0900
(704) 662-3270
(704) 662-3288
Mailing address
116 SOUTH MAIN STREET SUITE 205, PO BOX 900, MOORESVILLE, NC 28115-0900
(704) 662-3270
(704) 662-3288
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
Primary
35688
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0276R
BCBS GROUP NUMBER
NC
05
—
890276R
—
NC
Enumeration date
05/03/2007
Last updated
08/22/2020
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