Provider Demographics
NPI:1760867139
Name:STITH, WILMA
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:STITH
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 1:114 DENNIS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2917
Mailing Address - Country:US
Mailing Address - Phone:859-554-2090
Mailing Address - Fax:859-226-5025
Practice Address - Street 1:114 DENNIS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2917
Practice Address - Country:US
Practice Address - Phone:859-554-2090
Practice Address - Fax:859-226-5025
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2528691041C0700X
KY69281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical