MEDICARE: MRS. AMY MARIE KRANTZ METZGAR MA, LPC, NCC, NCSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4138	NC

General Provider Information

NPI Number	:	1073531430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY MARIE KRANTZ METZGAR MA, LPC, NCC, NCSC

Provider Business Mailing Address
First Line	:	PO BOX 4734
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4734
Country	:	US
Telephone Number	:	704-881-3884
Fax Number	:	704-896-7836

Provider Business Practice Location Address
First Line	:	8211 VILLAGE HARBOR DR
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-3706
Country	:	US
Telephone Number	:	704-881-3884
Fax Number	:	704-896-7836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/13/2008

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