Provider Demographics
NPI:1316386519
Name:PITTMAN, SHANA RUNNELS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:RUNNELS
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 WILSON PRAIRIE CIR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-3685
Mailing Address - Country:US
Mailing Address - Phone:407-496-7931
Mailing Address - Fax:
Practice Address - Street 1:1661 WILSON PRAIRIE CIR
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-3685
Practice Address - Country:US
Practice Address - Phone:407-496-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker