Provider Demographics
NPI:1336515873
Name:NEWMAN, JAN LARAE EVERHART (PHD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:LARAE EVERHART
Last Name:NEWMAN
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 1:301 S MCDOWELL ST STE 125
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-0031
Mailing Address - Country:US
Mailing Address - Phone:704-444-0087
Mailing Address - Fax:
Practice Address - Street 1:3318 PARTING BROOK CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8159
Practice Address - Country:US
Practice Address - Phone:704-444-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013103TB0200X, 103TC2200X, 103TC0700X
AL1924103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent