Provider Demographics
NPI:1821027988
Name:CHARLOTTE PSYCHOTHERAPY & CONSULTATION GROUP
Entity Type:Organization
Organization Name:CHARLOTTE PSYCHOTHERAPY & CONSULTATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-364-0452
Mailing Address - Street 1:417 S SHARON AMITY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2875
Mailing Address - Country:US
Mailing Address - Phone:704-364-0452
Mailing Address - Fax:704-364-5481
Practice Address - Street 1:417 S SHARON AMITY RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2875
Practice Address - Country:US
Practice Address - Phone:704-364-0452
Practice Address - Fax:704-364-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC892103TC0700X
NC1074103TC0700X
NC2061103TF0200X
NCC0039651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty