Provider Demographics
NPI:1609423136
Name:LECHNER, ETHAN (LCSWA, PHD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:
Last Name:LECHNER
Suffix:
Gender:M
Credentials:LCSWA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LANTERN WAY
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2470
Mailing Address - Country:US
Mailing Address - Phone:919-428-4842
Mailing Address - Fax:
Practice Address - Street 1:HOLISTIC COMMONS
Practice Address - Street 2:123 S. WALNUT CIRCLE
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409
Practice Address - Country:US
Practice Address - Phone:919-428-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0122311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical