Healthcare Provider Details

I. General information

NPI: 1700554482
Provider Name (Legal Business Name): ANN LOUISE PITNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N MILL ST
LITTLE MOUNTAIN SC
29075-8788
US

IV. Provider business mailing address

152 BURLIE DR
WEST COLUMBIA SC
29169-5303
US

V. Phone/Fax

Practice location:
  • Phone: 803-945-1005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: