Provider Demographics
NPI:1588640916
Name:MORETZ, LAWRENCE ANDERSON (MED)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ANDERSON
Last Name:MORETZ
Suffix:
Gender:M
Credentials:MED
Other - Prefix:MR
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:MORETZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 20323
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27120-0323
Mailing Address - Country:US
Mailing Address - Phone:336-761-5071
Mailing Address - Fax:
Practice Address - Street 1:115 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3741
Practice Address - Country:US
Practice Address - Phone:336-761-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2490101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor