Provider Demographics
NPI:1659506269
Name:ABLITZ, BRIAN W (PSYD, ABPP)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:ABLITZ
Suffix:
Gender:M
Credentials:PSYD, ABPP
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Mailing Address - Street 1:487 LAKE CONCORD RD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2934
Mailing Address - Country:US
Mailing Address - Phone:704-403-1705
Mailing Address - Fax:
Practice Address - Street 1:1100 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5814
Practice Address - Country:US
Practice Address - Phone:704-355-7328
Practice Address - Fax:704-355-7327
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1323103G00000X
NC5041103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist