=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609561661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH PITTMAN LCSW-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2023
-----------------------------------------------------
Last Update Date | 04/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3626 SHANNON RD STE 104
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27707-3596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-438-1067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 JONES FERRY RD APT I6
-----------------------------------------------------
City | CARRBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27510-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-257-3779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P018812
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------