Provider Demographics
NPI:1558527150
Name:DEWITT, DAVID MARK (LMFT, LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARK
Last Name:DEWITT
Suffix:
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2704
Mailing Address - Country:US
Mailing Address - Phone:412-430-4822
Mailing Address - Fax:
Practice Address - Street 1:610 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2704
Practice Address - Country:US
Practice Address - Phone:412-430-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004963101YM0800X
PAMF000633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024062040001Medicaid