Provider Demographics
NPI:1548344435
Name:ROTBERG, HEIDI L (PHD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:L
Last Name:ROTBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 COLTSGATE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3798
Mailing Address - Country:US
Mailing Address - Phone:704-807-1090
Mailing Address - Fax:
Practice Address - Street 1:2813 COLTSGATE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3798
Practice Address - Country:US
Practice Address - Phone:704-807-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1734HSPP103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist