Individual
THEA WOOTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LCASA
Contact information
Practice address
612 SIGNAL HILL DRIVE EXT, STATESVILLE, NC 28625-4353
(704) 872-0234
Mailing address
20014 NORTHPORT DR, CORNELIUS, NC 28031-6433
(704) 872-0234
(704) 818-1114
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23390
NC
Other
Enumeration date
03/09/2017
Last updated
03/09/2017
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