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General NPI Number Information
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NPI Number | 1669947552
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Entity Type | Individual
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Provider Name | MARK PHILLIP PITTS CAP, CCJAP
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Gender | Male
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 17356 US HIGHWAY 301 N
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City | STARKE
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State | FL
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Zip | 32091-1619
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Country | US
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Telephone | 904-827-7150
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Fax |
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Provider Business Mailing Address
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Address Line | 6629 VIRGINIA BEACH LANE
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City | KEYSTONE HEIGHTS
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State | FL
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Zip | 32656
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Country | US
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Telephone | 352-475-2517
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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