Provider Demographics
NPI:1295492080
Name:PITTMAN-PERSINGER, CHRISTINA (LSW, MA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:PITTMAN-PERSINGER
Suffix:
Gender:F
Credentials:LSW, MA
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:PITTMAN-PERSINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1946 OPOSSUM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:WV
Mailing Address - Zip Code:25938-7726
Mailing Address - Country:US
Mailing Address - Phone:304-640-2927
Mailing Address - Fax:
Practice Address - Street 1:1946 OPOSSUM CREEK RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:WV
Practice Address - Zip Code:25938-7726
Practice Address - Country:US
Practice Address - Phone:304-640-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00942229104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker