Provider Demographics
NPI:1134554868
Name:PITTS, AMY BUCHANAN (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BUCHANAN
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:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32329-0566
Mailing Address - Country:US
Mailing Address - Phone:850-323-0212
Mailing Address - Fax:
Practice Address - Street 1:300 TILTON ROAD
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320
Practice Address - Country:US
Practice Address - Phone:850-323-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW114971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical