Healthcare Provider Details

I. General information

NPI: 1376426585
Provider Name (Legal Business Name): AMY H. PETERMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5743 MCTAGGART LN
CHARLOTTE NC
28269-5210
US

IV. Provider business mailing address

5743 MCTAGGART LN
CHARLOTTE NC
28269-5210
US

V. Phone/Fax

Practice location:
  • Phone: 704-728-6530
  • Fax:
Mailing address:
  • Phone: 704-728-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3231
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: