Provider Demographics
NPI:1194373951
Name:WOOTEN, CARLY ALYSE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:ALYSE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:SEYMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1942 E 7TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2557
Mailing Address - Country:US
Mailing Address - Phone:704-360-3637
Mailing Address - Fax:
Practice Address - Street 1:1942 E 7TH ST STE 220
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2557
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NC5530103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist