Provider Demographics
NPI:1881606283
Name:STITT, ROSCOE DAVID (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:ROSCOE
Middle Name:DAVID
Last Name:STITT
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9844 LORI RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6691
Mailing Address - Country:US
Mailing Address - Phone:804-706-1111
Mailing Address - Fax:804-706-1185
Practice Address - Street 1:9844 LORI RD
Practice Address - Street 2:SUITE #100
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6691
Practice Address - Country:US
Practice Address - Phone:804-751-0453
Practice Address - Fax:804-796-1997
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000815106H00000X
VA0701002085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0005412196Medicaid