Provider Demographics
NPI:1518902394
Name:LUTTMANN, VICTOR M (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:LUTTMANN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 759194
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9194
Mailing Address - Country:US
Mailing Address - Phone:828-697-4187
Mailing Address - Fax:828-697-4488
Practice Address - Street 1:1430 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2302
Practice Address - Country:US
Practice Address - Phone:828-697-4187
Practice Address - Fax:828-697-4488
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0009501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002702Medicaid
NC2865409DMedicare PIN