Healthcare Provider Details

I. General information

NPI: 1376926568
Provider Name (Legal Business Name): KAROLINE PITTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 JEFFERSON ST NE STE 300
ALBUQUERQUE NM
87109-4314
US

IV. Provider business mailing address

7850 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4315
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1114
  • Fax:
Mailing address:
  • Phone: 801-608-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0219031
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: