Provider Demographics
NPI:1669755781
Name:CHITTERSON, TOMICA T (MA, PCC-S)
Entity type:Individual
Prefix:
First Name:TOMICA
Middle Name:T
Last Name:CHITTERSON
Suffix:
Gender:F
Credentials:MA, PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6457 GLENWAY AVE # 115
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5233
Mailing Address - Country:US
Mailing Address - Phone:513-202-6202
Mailing Address - Fax:
Practice Address - Street 1:7781 COOPER RD STE 5
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7728
Practice Address - Country:US
Practice Address - Phone:513-202-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0500006-SUPV101YP2500X
OHE0500006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional