Healthcare Provider Details

I. General information

NPI: 1689408924
Provider Name (Legal Business Name): MARGARET KOTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CAUSEWAY DR STE A2530
WRIGHTSVILLE BEACH NC
28480-1959
US

IV. Provider business mailing address

3602 STEMBRIDGE CT
WILMINGTON NC
28409-2844
US

V. Phone/Fax

Practice location:
  • Phone: 910-619-5873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA19200
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: