Healthcare Provider Details

I. General information

NPI: 1669755781
Provider Name (Legal Business Name): TOMICA T CHITTERSON MA, PCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2011
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7781 COOPER RD STE 5
CINCINNATI OH
45242-7728
US

IV. Provider business mailing address

6457 GLENWAY AVE # 115
CINCINNATI OH
45211-5233
US

V. Phone/Fax

Practice location:
  • Phone: 513-202-6202
  • Fax:
Mailing address:
  • Phone: 513-202-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0500006
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0500006-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: