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General NPI Number Information
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NPI Number | 1871813352
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Entity Type | Organization
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Legal Business Name | LAKE NORMAN CHILD AND ADOLESCENT PSYCHIATRY
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 223 WILLIAMSON RD SUITE 103
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City | MOORESVILLE
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State | NC
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Zip | 28117-8198
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Country | US
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Telephone | 704-660-5686
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Fax | 704-696-1027
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Provider Business Mailing Address
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Address Line | 223 WILLIAMSON RD SUITE 103
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City | MOORESVILLE
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State | NC
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Zip | 28117-8198
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Country | US
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Telephone | 704-660-5686
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Fax | 704-696-1027
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. CHRISTOPHER FOX
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Credential | D.O.
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Telephone | 440-666-8136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2010-00723
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 2010-00723
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License Number State | NC
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