Provider Demographics
NPI:1669947552
Name:PITTS, MARK PHILLIP (CAP, CCJAP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:PHILLIP
Last Name:PITTS
Suffix:
Gender:M
Credentials:CAP, CCJAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6629 VIRGINIA BEACH LANE
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656
Mailing Address - Country:US
Mailing Address - Phone:352-475-2517
Mailing Address - Fax:
Practice Address - Street 1:17356 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-1619
Practice Address - Country:US
Practice Address - Phone:904-827-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty