Provider Demographics
NPI:1477739894
Name:PITTMAN, KATRINA HANNAH (EDD, LPC, NCC, CAMS)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:HANNAH
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:EDD, LPC, NCC, CAMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 GOSSAMERE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7006
Mailing Address - Country:US
Mailing Address - Phone:678-289-0789
Mailing Address - Fax:678-289-0789
Practice Address - Street 1:3021 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4529
Practice Address - Country:US
Practice Address - Phone:404-808-3419
Practice Address - Fax:678-289-0789
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003631101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health