Individual
SYNOVIA PETTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAS
Contact information
Practice address
3815 N TRYON ST, CHARLOTTE, NC 28206-2060
(704) 372-8806
(704) 372-6920
Mailing address
3815 N TRYON ST, CHARLOTTE, NC 28206-2060
(704) 372-8806
(704) 372-6920
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
877
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
877
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21286
—
NC
Enumeration date
04/09/2019
Last updated
04/09/2019
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