Provider Demographics
NPI:1093836736
Name:PITTS, MILLICENT LAQUITA (MARRIAGE FAMILY THER)
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:LAQUITA
Last Name:PITTS
Suffix:
Gender:F
Credentials:MARRIAGE FAMILY THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12808 HAWAII LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-8276
Mailing Address - Country:US
Mailing Address - Phone:661-587-1294
Mailing Address - Fax:
Practice Address - Street 1:4200 CRESCENT ROCK LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-2860
Practice Address - Country:US
Practice Address - Phone:661-491-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91208OtherBBS