Provider Demographics
NPI:1184143042
Name:POPULATIONS AND INTERVENTIONS TEAM COMPANY (PITC)
Entity type:Organization
Organization Name:POPULATIONS AND INTERVENTIONS TEAM COMPANY (PITC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:MERRITT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, MPH, ABVE, CCM
Authorized Official - Phone:678-310-9707
Mailing Address - Street 1:3182 BERTHAS OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8458
Mailing Address - Country:US
Mailing Address - Phone:678-310-9707
Mailing Address - Fax:470-875-0083
Practice Address - Street 1:3182 BERTHAS OVERLOOK
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8458
Practice Address - Country:US
Practice Address - Phone:678-310-9707
Practice Address - Fax:470-875-0083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POPULATIONS AND INTERVENTIONS TEAM COMPANY (PITC)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28315225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty