Provider Demographics
NPI:1023537842
Name:WITTY, ADELINE REBECCA
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:REBECCA
Last Name:WITTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 FRIENDSHIP VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952
Mailing Address - Country:US
Mailing Address - Phone:310-590-9896
Mailing Address - Fax:
Practice Address - Street 1:622 FRIENDSHIP VILLAGE DR
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-3292
Practice Address - Country:US
Practice Address - Phone:310-590-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC611728101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor