Provider Demographics
NPI:1821313958
Name:PITTMAN, ANTHONY (MA, LCAS)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:MA, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-1730
Mailing Address - Country:US
Mailing Address - Phone:910-628-5655
Mailing Address - Fax:888-241-5857
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-1730
Practice Address - Country:US
Practice Address - Phone:910-628-5655
Practice Address - Fax:888-241-5857
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1665101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)