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General NPI Number Information
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NPI Number | 1255429445
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Entity Type | Individual
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Provider Name | MELISSA RAE GORDON-PITTS LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 4921 PROFESSIONAL CT SUITE 201B
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City | RALEIGH
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State | NC
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Zip | 27609-4913
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Country | US
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Telephone | 877-278-7317
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Fax | 877-278-7317
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Provider Business Mailing Address
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Address Line | 4921 PROFESSIONAL CT SUITE 201B
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City | RALEIGH
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State | NC
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Zip | 27609-4913
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Country | US
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Telephone | 877-278-7317
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Fax | 877-278-7317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13672
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C010020
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904008672
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License Number State | VA
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