Provider Demographics
NPI:1386396307
Name:PATTON, ORTAVIA (LCAS, LCMHCA)
Entity type:Individual
Prefix:
First Name:ORTAVIA
Middle Name:
Last Name:PATTON
Suffix:
Gender:F
Credentials:LCAS, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-7229
Mailing Address - Country:US
Mailing Address - Phone:704-560-9926
Mailing Address - Fax:
Practice Address - Street 1:280 CONCORD PKWY S STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2705
Practice Address - Country:US
Practice Address - Phone:704-560-9926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13414101YM0800X
NC23523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)