Healthcare Provider Details

I. General information

NPI: 1811810609
Provider Name (Legal Business Name): ZACHARY WITTES LGPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 AUGUST DR
ANNAPOLIS MD
21403-4624
US

IV. Provider business mailing address

1143 AUGUST DR
ANNAPOLIS MD
21403-4624
US

V. Phone/Fax

Practice location:
  • Phone: 404-895-5392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18241
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: