Healthcare Provider Details

I. General information

NPI: 1134606080
Provider Name (Legal Business Name): ADAM KURTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 GATEWAY BLVD STE 207
MOORESVILLE NC
28117-5597
US

IV. Provider business mailing address

108 GATEWAY BLVD STE 207
MOORESVILLE NC
28117-5597
US

V. Phone/Fax

Practice location:
  • Phone: 980-222-1056
  • Fax:
Mailing address:
  • Phone: 980-222-1056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA24464
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA14048
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14048
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA14048
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: