Basic Information
| Provider Information | |||||||||
| NPI: | 1992905749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BITTLE | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | ANNETTE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751803 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367183550 | ||||||||
| FaxNumber: | 3362771825 | ||||||||
| Practice Location | |||||||||
| Address1: | 3545 WHITEHALL PARK STE. | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9803028850 | ||||||||
| FaxNumber: | 7043168118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2007 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4234 | NC | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 4234 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.