Provider Demographics
NPI:1871813352
Name:LAKE NORMAN CHILD AND ADOLESCENT PSYCHIATRY
Entity type:Organization
Organization Name:LAKE NORMAN CHILD AND ADOLESCENT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-666-8136
Mailing Address - Street 1:223 WILLIAMSON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8198
Mailing Address - Country:US
Mailing Address - Phone:704-660-5686
Mailing Address - Fax:704-696-1027
Practice Address - Street 1:223 WILLIAMSON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8198
Practice Address - Country:US
Practice Address - Phone:704-660-5686
Practice Address - Fax:704-696-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-007232084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty