Organization
BASE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREA UMBACH KETTLING PSYD (CO-OWNER/LICENSED PSYCHOLOGIST)
(704) 910-8381
Entity
Organization
Contact information
Practice address
1515 MOCKINGBIRD LN STE 580, CHARLOTTE, NC 28209-3236
(704) 910-8381
(704) 981-8282
Mailing address
1515 MOCKINGBIRD LN STE 580, CHARLOTTE, NC 28209-3236
(704) 910-8381
(704) 981-8282
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
Other
Enumeration date
03/23/2018
Last updated
08/06/2019
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