Provider Demographics
NPI:1285818492
Name:TITTA, CAROL (MFT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:TITTA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9112 MADISON GREENS LANE
Mailing Address - Street 2:#21
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662
Mailing Address - Country:US
Mailing Address - Phone:916-207-4762
Mailing Address - Fax:916-608-9284
Practice Address - Street 1:6765 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8984
Practice Address - Country:US
Practice Address - Phone:530-622-5551
Practice Address - Fax:530-622-5800
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health