Provider Demographics
NPI:1487927315
Name:KNUTH, SEAN BRIAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:BRIAN
Last Name:KNUTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 PIEDMONT ROW DR S
Mailing Address - Street 2:STE 120
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28287-3884
Mailing Address - Country:US
Mailing Address - Phone:704-552-0116
Mailing Address - Fax:704-552-7550
Practice Address - Street 1:6060 PIEDMONT ROW DR S
Practice Address - Street 2:STE 120
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28287-3884
Practice Address - Country:US
Practice Address - Phone:704-552-0116
Practice Address - Fax:704-552-7550
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist