Provider Demographics
NPI:1093074841
Name:PITTS-THOMAS, LACONYEA DYLANA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LACONYEA
Middle Name:DYLANA
Last Name:PITTS-THOMAS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2006
Mailing Address - Country:US
Mailing Address - Phone:219-985-8695
Mailing Address - Fax:
Practice Address - Street 1:322 W 55TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2006
Practice Address - Country:US
Practice Address - Phone:219-985-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006504A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical