Provider Demographics
NPI:1093803322
Name:WITTE, EDWARD J (LPC, CCDC III)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:WITTE
Suffix:
Gender:M
Credentials:LPC, CCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 LITTLE YORK RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2409
Mailing Address - Country:US
Mailing Address - Phone:937-275-6510
Mailing Address - Fax:937-264-1101
Practice Address - Street 1:315 PUBLIC SQ
Practice Address - Street 2:209
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-5202
Practice Address - Country:US
Practice Address - Phone:937-339-0057
Practice Address - Fax:937-264-1101
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC4928101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9442930OtherCIGNA