Tynnatta Maria Pettit, LCSW-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P017328 Issued in NC

Practice address

7400 Carmel Executive Park Dr
Charlotte, NC 28226-8400

Phone

(704) 885-0268

NPI assigned

Jun 16, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1467012138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 POINT WYLIE LN",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088387",
            "telephone_number": "757-710-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 CARMEL EXECUTIVE PARK DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282268400",
            "telephone_number": "704-885-0268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "TYNNATTA",
        "middle_name": "MARIA",
        "name_prefix": "Ms.",
        "credential": "LCSW-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-16",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P017328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Marie Pettine, AU.D.
• Karlton Shea Pettis, MD
• Pamela Cobb Pettis, MD
• Angela Pettit, CSAC
• Crystal Shannon Pettit, MAED
• Zachary David Pettit, PA-C
• Brooke Freeman Pettitt, PHARMD
• Keshia Pettus
• Cole Petty, LCMHCA
• Grant Petty, PHARMD

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.