Healthcare Provider Details

I. General information

NPI: 1881606283
Provider Name (Legal Business Name): ROSCOE DAVID STITT LPC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9844 LORI RD SUITE #100
CHESTERFIELD VA
23832-6691
US

IV. Provider business mailing address

9844 LORI RD SUITE #100
CHESTERFIELD VA
23832-6691
US

V. Phone/Fax

Practice location:
  • Phone: 804-751-0453
  • Fax: 804-796-1997
Mailing address:
  • Phone: 804-706-1111
  • Fax: 804-706-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002085
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000815
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: