Provider Demographics
NPI:1790029791
Name:MERMELSTEIN, DAVID E (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:MERMELSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 FAIRVIEW RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3297
Mailing Address - Country:US
Mailing Address - Phone:704-372-0670
Mailing Address - Fax:
Practice Address - Street 1:6201 FAIRVIEW ROAD, STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3297
Practice Address - Country:US
Practice Address - Phone:704-372-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical