Individual
DR. NISHTHAYA SOUKHANOUVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
3743 LATROBE DR, CHARLOTTE, NC 28211-1164
(704) 826-2709
(571) 257-0906
Mailing address
3743 LATROBE DR, CHARLOTTE, NC 28211-1164
(704) 826-2709
(571) 257-0906
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5747
NC
Other
Enumeration date
10/02/2018
Last updated
12/04/2023
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