Healthcare Provider Details

I. General information

NPI: 1760482814
Provider Name (Legal Business Name): CATHERINE L. PITTS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 1ST ST. ATTN: 49TH MDG, FAMILY ADVOCACY, MENTAL HEALTH CLINIC
HOLLOMAN AFB NM
88330
US

IV. Provider business mailing address

280 FIRST ST 49TH MEDICAL GROUP, ATTN: FAMILY ADVOCACY
HOLLOMAN AFB NM
88330
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-7061
  • Fax:
Mailing address:
  • Phone: 575-572-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003965
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: