MEDICARE: CHRISTINA MARIE NEITZ MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	786	NC
2	103T00000X	Psychologist	1878	NC

General Provider Information

NPI Number	:	1447411582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE NEITZ MA

Provider Business Mailing Address
First Line	:	8718 BARRELLI CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0269
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8718 BARRELLI CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0269
Country	:	US
Telephone Number	:	704-321-3021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/20/2008

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Directions to “ CHRISTINA MARIE NEITZ MA” Practice Location

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