Provider Demographics
NPI:1083764534
Name:WENTZ, CHARLES JAMES JR (MA, LCMHCS, LPC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JAMES
Last Name:WENTZ
Suffix:JR
Gender:M
Credentials:MA, LCMHCS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LAUCHWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5540
Mailing Address - Country:US
Mailing Address - Phone:910-276-7011
Mailing Address - Fax:910-276-7060
Practice Address - Street 1:601 LAUCHWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5540
Practice Address - Country:US
Practice Address - Phone:910-276-7011
Practice Address - Fax:910-276-7060
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5162101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141Y3OtherBCBS
NC186211OtherMEDCOST
NC6103157Medicaid