Healthcare Provider Details

I. General information

NPI: 1831710052
Provider Name (Legal Business Name): MADISON PITTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 CUTSHAW AVE STE 200
RICHMOND VA
23230-3630
US

IV. Provider business mailing address

306 N KENSINGTON AVE
LA GRANGE PARK IL
60526-1870
US

V. Phone/Fax

Practice location:
  • Phone: 312-965-2997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: