MEDICARE: KATINA PITTMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC005782	GA

General Provider Information

NPI Number	:	1588395594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATINA PITTMAN LPC

Provider Business Mailing Address
First Line	:	957 MAIN ST STE A381
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3060
Country	:	US
Telephone Number	:	404-939-2349
Fax Number	:

Provider Business Practice Location Address
First Line	:	957 MAIN ST STE A381
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3060
Country	:	US
Telephone Number	:	404-939-2349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/05/2023

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Directions to “ KATINA PITTMAN LPC” Practice Location

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