Mark David Worthen, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1835 Issued in NC

Practice address

15720 Brixham Hill Ave Ste 300
Charlotte, NC 28277-4784

Phone

(980) 391-6309

Fax

(980) 729-5870

NPI assigned

Jul 18, 2006

Last updated

May 18, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Mark D Worthen PSYD Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715990400000",
    "number": "1770502379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 410105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282410105",
            "telephone_number": "980-391-6309",
            "fax_number": "980-729-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15720 BRIXHAM HILL AVE STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282774784",
            "telephone_number": "980-391-6309",
            "fax_number": "980-729-5870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WORTHEN",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2024-05-18",
        "certification_date": "2024-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1835",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "1835",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000718",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "WORTHEN PSYD",
            "middle_name": "D",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Karen Lynette Worrell, LCSW
• Leanna Jo Worsham, NP
• Corinne Arlene Worth, ARNP
• Richard P Worth, NP
• Susan Wortham-Oyach
• Sta'Ce Worthy-Hill, RNFA,BSN
• Christine Ann Worthy, NP
• Wotp Programs Inc
• Wotp Programs, Inc.
• Wound Pros North Carolina

• Clinical Psychologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2024; 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.