Provider Demographics
NPI:1467012138
Name:PETTIT, TYNNATTA MARIA (LCSW-A)
Entity Type:Individual
Prefix:MS
First Name:TYNNATTA
Middle Name:MARIA
Last Name:PETTIT
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 POINT WYLIE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8387
Mailing Address - Country:US
Mailing Address - Phone:757-710-3416
Mailing Address - Fax:
Practice Address - Street 1:7400 CARMEL EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8400
Practice Address - Country:US
Practice Address - Phone:704-885-0268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
NCP0173281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical