Provider Demographics
NPI:1205861002
Name:GETTELMAN, THOMAS E (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:GETTELMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-801-9200
Mailing Address - Fax:704-801-9201
Practice Address - Street 1:16740 DAVIDSON CONCORD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8746
Practice Address - Country:US
Practice Address - Phone:704-801-9200
Practice Address - Fax:704-801-9201
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0542Medicaid
NC2819868Medicare PIN
SCPS0542Medicaid