Provider Demographics
NPI:1215408976
Name:PITTS WATKINS, KRISTEONA SIRAH (EDS, ALC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEONA
Middle Name:SIRAH
Last Name:PITTS WATKINS
Suffix:
Gender:F
Credentials:EDS, ALC
Other - Prefix:
Other - First Name:KRISTEONA
Other - Middle Name:SIRAH
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 FARMINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-7850
Mailing Address - Country:US
Mailing Address - Phone:601-573-9899
Mailing Address - Fax:
Practice Address - Street 1:8840 MADISON BLVD
Practice Address - Street 2:SUITE 200-Q
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2622
Practice Address - Country:US
Practice Address - Phone:256-469-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ALC3424A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health