Provider Demographics
NPI:1275021867
Name:PITTMAN, WILEY THOMAS (LCMHC)
Entity type:Individual
Prefix:
First Name:WILEY
Middle Name:THOMAS
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 EASTWOOD RD STE 223
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7234
Mailing Address - Country:US
Mailing Address - Phone:910-632-0776
Mailing Address - Fax:
Practice Address - Street 1:1908 EASTWOOD RD STE 223
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7234
Practice Address - Country:US
Practice Address - Phone:910-632-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty