Healthcare Provider Details

I. General information

NPI: 1710472378
Provider Name (Legal Business Name): PAMELA A WITT LCSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BOND ST STE 127
NAPERVILLE IL
60563-2769
US

IV. Provider business mailing address

732 BUCKINGHAM CT
WHEATON IL
60189-8100
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-9002
  • Fax:
Mailing address:
  • Phone: 630-204-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number31244
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009031
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: