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General NPI Number Information
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NPI Number | 1972847028
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Entity Type | Individual
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Provider Name | MIA PETTIT LCSW, CCDP-D, CAADC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 600 N BROAD ST STE 5NO715
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1032
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Country | US
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Telephone | 302-526-0946
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Fax |
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Provider Business Mailing Address
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Address Line | 2841 S STATE ST
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City | CAMDEN
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State | DE
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Zip | 19934-1978
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Country | US
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Telephone | 302-698-8410
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Fax | 302-698-8419
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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 | Q1-0001164
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License Number State | DE
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