Provider Demographics
NPI:1851521751
Name:LUTZ, BEVERLY (LCSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 APRIL MIST TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2344
Mailing Address - Country:US
Mailing Address - Phone:704-491-8220
Mailing Address - Fax:
Practice Address - Street 1:7307 APRIL MIST TRL
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2344
Practice Address - Country:US
Practice Address - Phone:704-491-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-26
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0036171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical