Provider Demographics
NPI:1275087132
Name:BRETZ, JOSEPH WARREN IV (MED, LPC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WARREN
Last Name:BRETZ
Suffix:IV
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FIRST UNITED METHODIST CHURCH
Mailing Address - Street 2:340 HAWTHORNE ROAD
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-3021
Mailing Address - Country:US
Mailing Address - Phone:336-838-1644
Mailing Address - Fax:336-667-7720
Practice Address - Street 1:340 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-3021
Practice Address - Country:US
Practice Address - Phone:336-838-1644
Practice Address - Fax:336-667-7720
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional