Provider Demographics
NPI:1497339147
Name:PITTS, STEPHANIE (MA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:PITTS-RILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1000 JEFFERSON ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-1724
Mailing Address - Country:US
Mailing Address - Phone:434-258-3005
Mailing Address - Fax:
Practice Address - Street 1:1000 JEFFERSON ST STE 2C
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-1724
Practice Address - Country:US
Practice Address - Phone:434-258-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARBT-21-160776Medicaid