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NPI Code Detail

MEDICARE: DR. CARLY ALYSE WOOTEN PSYD

MEDICARE: DR. CARLY ALYSE WOOTEN PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
2103TC0700XClinical Psychologist5530NC

General Provider Information

NPI Number : 1194373951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARLY ALYSE WOOTEN PSYD
Provider Business Mailing Address
First Line : 1942 E 7TH ST STE 220
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2557
Country : US
Telephone Number : 704-360-3637
Fax Number :
Provider Business Practice Location Address
First Line : 1942 E 7TH ST STE 220
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2557
Country : US
Telephone Number : 704-360-3637
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2019
Last Update Date : 08/07/2025

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