Healthcare Provider Details

I. General information

NPI: 1720691512
Provider Name (Legal Business Name): DOMINICK PITTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NA NA LGSW

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 DOUGLASS RD SE
WASHINGTON DC
20020-6504
US

IV. Provider business mailing address

2600 DOUGLASS RD SE
WASHINGTON DC
20020-6504
US

V. Phone/Fax

Practice location:
  • Phone: 202-750-2781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLG50083319
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: