Healthcare Provider Details

I. General information

NPI: 1477118677
Provider Name (Legal Business Name): CAMERON PITTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 WILDWOOD CENTRE DR
COLUMBIA SC
29229-8420
US

IV. Provider business mailing address

209 7TH ST FL 3
AUGUSTA GA
30901-1486
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-5330
  • Fax: 706-842-5340
Mailing address:
  • Phone: 706-842-5330
  • Fax: 706-842-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72382
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14658
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-84992
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: