Provider Demographics
NPI:1275021867
Name:PITTMAN, WILEY THOMAS (LPCA)
Entity Type:Individual
Prefix:
First Name:WILEY
Middle Name:THOMAS
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-0491
Mailing Address - Country:US
Mailing Address - Phone:252-646-3410
Mailing Address - Fax:
Practice Address - Street 1:4425 ARENDELL ST UNIT 104
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2774
Practice Address - Country:US
Practice Address - Phone:252-646-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12730103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling