Provider Demographics
NPI:1720396716
Name:LAKE NORMAN COUNSELING & PASTORAL CARE CENTER
Entity Type:Organization
Organization Name:LAKE NORMAN COUNSELING & PASTORAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARR
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFTA
Authorized Official - Phone:704-928-9390
Mailing Address - Street 1:804 FIELDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2732
Mailing Address - Country:US
Mailing Address - Phone:704-928-9390
Mailing Address - Fax:866-321-9367
Practice Address - Street 1:804 FIELDSTONE RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2732
Practice Address - Country:US
Practice Address - Phone:704-928-9390
Practice Address - Fax:866-321-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7015A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty