Provider Demographics
NPI:1154525236
Name:LOTHES, JOHN EDWARD II (MA, LPA, HS-PA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:LOTHES
Suffix:II
Gender:M
Credentials:MA, LPA, HS-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2922
Mailing Address - Country:US
Mailing Address - Phone:910-232-5469
Mailing Address - Fax:
Practice Address - Street 1:4930 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2922
Practice Address - Country:US
Practice Address - Phone:910-232-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2589103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist