Healthcare Provider Details

I. General information

NPI: 1134618390
Provider Name (Legal Business Name): MISS EBONY LATOYA PITTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 S HIGHWAY 29
CANTONMENT FL
32533-5808
US

IV. Provider business mailing address

1363 RANDOM OAKS PL
PENSACOLA FL
32514-3316
US

V. Phone/Fax

Practice location:
  • Phone: 850-968-3565
  • Fax:
Mailing address:
  • Phone: 850-390-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: