Individual
MARK DAVID WORTHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
15720 BRIXHAM HILL AVE STE 300, CHARLOTTE, NC 28277-4784
(980) 391-6309
(980) 729-5870
Mailing address
PO BOX 410105, CHARLOTTE, NC 28241-0105
(980) 391-6309
(980) 729-5870
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
1835
NC
103TC0700X
Clinical Psychologist
Primary
1835
NC
103TF0200X
Forensic Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6000718
—
NC
Enumeration date
07/18/2006
Last updated
05/18/2024
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