Healthcare Provider Details

I. General information

NPI: 1477739894
Provider Name (Legal Business Name): KATRINA HANNAH PITTMAN ED.D, LPC, NCC, CAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 WASHINGTON RD
EAST POINT GA
30344-4529
US

IV. Provider business mailing address

1010 GOSSAMERE WAY
STOCKBRIDGE GA
30281-7006
US

V. Phone/Fax

Practice location:
  • Phone: 404-808-3419
  • Fax: 678-289-0789
Mailing address:
  • Phone: 678-289-0789
  • Fax: 678-289-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC003631
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC003631
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: