Provider Demographics
NPI:1902439672
Name:CHITTUM, MARY SUSAN (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:CHITTUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 E HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1620
Mailing Address - Country:US
Mailing Address - Phone:540-965-6135
Mailing Address - Fax:540-965-6371
Practice Address - Street 1:311 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1635
Practice Address - Country:US
Practice Address - Phone:540-965-2100
Practice Address - Fax:540-965-2105
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional