Provider Demographics
NPI:1417738816
Name:PITTMAN, SHARON DENISE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 APPLEGATE LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3854
Mailing Address - Country:US
Mailing Address - Phone:415-763-9180
Mailing Address - Fax:
Practice Address - Street 1:1441 APPLEGATE LN
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3854
Practice Address - Country:US
Practice Address - Phone:415-763-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)