Provider Demographics
NPI:1316782105
Name:LANTZ, KATERINA (LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:LANTZ
Suffix:
Gender:F
Credentials:LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5466 WERBURGH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3688
Mailing Address - Country:US
Mailing Address - Phone:717-926-2869
Mailing Address - Fax:
Practice Address - Street 1:5970 FAIRVIEW RD STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3491
Practice Address - Country:US
Practice Address - Phone:704-750-5906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health