Provider Demographics
NPI:1548869050
Name:PITTMAN, HEATHER LIZBETH
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LIZBETH
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4672
Mailing Address - Country:US
Mailing Address - Phone:209-361-4733
Mailing Address - Fax:
Practice Address - Street 1:541 S HAM LN
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3530
Practice Address - Country:US
Practice Address - Phone:209-224-8940
Practice Address - Fax:209-224-5076
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)