Provider Demographics
NPI:1336478676
Name:KOROTITSCH, WILLIAM
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:KOROTITSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 W MEADOWVIEW RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3409
Mailing Address - Country:US
Mailing Address - Phone:336-855-4649
Mailing Address - Fax:336-855-4645
Practice Address - Street 1:2211 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3409
Practice Address - Country:US
Practice Address - Phone:336-855-4649
Practice Address - Fax:336-855-4645
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2316103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist