Provider Demographics
NPI:1275661373
Name:KLINETOB, NADYA A (PHD)
Entity Type:Individual
Prefix:
First Name:NADYA
Middle Name:A
Last Name:KLINETOB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10508 PARK RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8525
Mailing Address - Country:US
Mailing Address - Phone:704-541-9080
Mailing Address - Fax:704-542-0699
Practice Address - Street 1:10508 PARK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8525
Practice Address - Country:US
Practice Address - Phone:704-541-9080
Practice Address - Fax:704-542-0699
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical