Provider Demographics
NPI:1942774948
Name:LORENZ, CHRISTOPHER MICHAEL (LADC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:LORENZ
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 UNIVERSITY AVE W STE 20
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4747
Mailing Address - Country:US
Mailing Address - Phone:612-373-9160
Mailing Address - Fax:612-373-2407
Practice Address - Street 1:1000 UNIVERSITY AVE W STE 20
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4747
Practice Address - Country:US
Practice Address - Phone:612-373-9160
Practice Address - Fax:612-373-2407
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304674101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)