Provider Demographics
NPI:1164852083
Name:PITTMAN, MAYA MITCHELL (LCMHCS)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:MITCHELL
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4304 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-6819
Mailing Address - Country:US
Mailing Address - Phone:828-280-6343
Mailing Address - Fax:
Practice Address - Street 1:4304 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-6819
Practice Address - Country:US
Practice Address - Phone:828-280-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS9161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health