Provider Demographics
NPI:1811095151
Name:PITTMAN, SUSAN ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANNE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3806
Mailing Address - Country:US
Mailing Address - Phone:252-727-5279
Mailing Address - Fax:252-726-0298
Practice Address - Street 1:105 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3806
Practice Address - Country:US
Practice Address - Phone:252-727-5279
Practice Address - Fax:252-726-0298
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCC0048951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003145Medicaid
NC6003145Medicaid