Healthcare Provider Details

I. General information

NPI: 1245756295
Provider Name (Legal Business Name): LKN COUNSELING AND SEX THERAPY, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHARLESTON DR UNIT 109108
MOORESVILLE NC
28117-7700
US

IV. Provider business mailing address

110 CHARLESTON DR UNIT 109108
MOORESVILLE NC
28117-7700
US

V. Phone/Fax

Practice location:
  • Phone: 980-444-0806
  • Fax: 206-350-6056
Mailing address:
  • Phone: 980-444-0806
  • Fax: 206-350-6056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9293
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010304
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17171
License Number StateNC

VIII. Authorized Official

Name: DR. PATRICIA LITTWIN
Title or Position: OWNER
Credential: PSY.D., LPC, CST
Phone: 980-475-0560