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NPI Code Detail

MEDICARE: MS. CAROL B PITTS PH.D., LPC, LMFT

MEDICARE: MS. CAROL B PITTS PH.D., LPC, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP1600XPastoral Counselor
2101YP2500XProfessional CounselorLPC001788GA
3106H00000XMarriage & Family TherapistMFT000795GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
158-0899552OTHERGATAX IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1427047125
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROL B PITTS PH.D., LPC, LMFT
Provider Business Mailing Address
First Line : 1814 CLAIRMONT RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-3405
Country : US
Telephone Number : 404-636-1457
Fax Number : 404-636-7449
Provider Business Practice Location Address
First Line : 1814 CLAIRMONT RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-3405
Country : US
Telephone Number : 404-636-1457
Fax Number : 404-636-7449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 02/06/2019

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