Provider Demographics
NPI:1669794038
Name:PITTMAN, DEMIETRICE LYNETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:DEMIETRICE
Middle Name:LYNETTE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 DUNSTAN RD
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-7532
Mailing Address - Country:US
Mailing Address - Phone:210-347-2047
Mailing Address - Fax:
Practice Address - Street 1:2503 DUNSTAN RD
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7532
Practice Address - Country:US
Practice Address - Phone:210-347-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS49855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical