Provider Demographics
NPI:1225739766
Name:HENSON-PITTMAN, KIRA (EDS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:KIRA
Middle Name:
Last Name:HENSON-PITTMAN
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 HONAKER AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3065
Mailing Address - Country:US
Mailing Address - Phone:304-487-1551
Mailing Address - Fax:
Practice Address - Street 1:1403 HONAKER AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3065
Practice Address - Country:US
Practice Address - Phone:304-487-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRBT-22-229357106S00000X
WV103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician