Provider Demographics
NPI:1013520204
Name:WITTE, TRICIA (PHD)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:WITTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 WOODLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-5420
Mailing Address - Country:US
Mailing Address - Phone:205-266-3425
Mailing Address - Fax:
Practice Address - Street 1:4405 WOODLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-5420
Practice Address - Country:US
Practice Address - Phone:205-266-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1378103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist