Provider Demographics
NPI:1992905749
Name:BITTLE, TRAVIS ANNETTE (MA LPC)
Entity type:Individual
Prefix:MS
First Name:TRAVIS
Middle Name:ANNETTE
Last Name:BITTLE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-3550
Mailing Address - Fax:336-277-1825
Practice Address - Street 1:3545 WHITEHALL PARK STE.
Practice Address - Street 2:STE. 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273
Practice Address - Country:US
Practice Address - Phone:980-302-8850
Practice Address - Fax:704-316-8118
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4234101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional