Provider Demographics
NPI:1831314939
Name:PITTMAN, JARITA MICKEL (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JARITA
Middle Name:MICKEL
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 POPLAR AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3974
Mailing Address - Country:US
Mailing Address - Phone:901-627-1289
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:6000 POPLAR AVE STE 250
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3974
Practice Address - Country:US
Practice Address - Phone:901-627-1289
Practice Address - Fax:870-972-4911
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5885101YM0800X
TN143801797023747A0650X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered376J00000XNursing Service Related ProvidersHomemaker