Healthcare Provider Details

I. General information

NPI: 1578883260
Provider Name (Legal Business Name): VIRGINIA WITTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S 9TH ST
TACOMA WA
98405-4014
US

IV. Provider business mailing address

1221 S 9TH ST
TACOMA WA
98405-4014
US

V. Phone/Fax

Practice location:
  • Phone: 585-305-4217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60589203
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: