Healthcare Provider Details

I. General information

NPI: 1700702230
Provider Name (Legal Business Name): TERRELL PITTS COUNSELING INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WESTWOOD AVE
WATERBURY CT
06708-2460
US

IV. Provider business mailing address

53 ALLENTOWN RD
BRISTOL CT
06010-5902
US

V. Phone/Fax

Practice location:
  • Phone: 860-261-3162
  • Fax:
Mailing address:
  • Phone: 860-261-3162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: