Provider Demographics
NPI:1760482814
Name:PITTS, CATHERINE L (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:PITTS
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 1:280 FIRST ST
Mailing Address - Street 2:49TH MEDICAL GROUP, ATTN: FAMILY ADVOCACY
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330
Mailing Address - Country:US
Mailing Address - Phone:575-572-7061
Mailing Address - Fax:
Practice Address - Street 1:280 1ST ST.
Practice Address - Street 2:ATTN: 49TH MDG, FAMILY ADVOCACY, MENTAL HEALTH CLINIC
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330
Practice Address - Country:US
Practice Address - Phone:575-572-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040039651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010113865Medicaid
VA0904003965OtherLIC