Healthcare Provider Details

I. General information

NPI: 1396823118
Provider Name (Legal Business Name): JAN DANIEL LHOTSKY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 PINEDALE RD STE B
GREENSBORO NC
27408-2018
US

IV. Provider business mailing address

2709 PINEDALE RD STE B
GREENSBORO NC
27408-2018
US

V. Phone/Fax

Practice location:
  • Phone: 336-420-7910
  • Fax: 336-641-3595
Mailing address:
  • Phone: 336-420-7910
  • Fax: 336-641-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number669
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: