Provider Demographics
NPI:1336788900
Name:PITTS, JAZZMIN
Entity type:Individual
Prefix:
First Name:JAZZMIN
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAZZMIN
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5900 N LILLEY RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3695
Mailing Address - Country:US
Mailing Address - Phone:734-981-3709
Mailing Address - Fax:
Practice Address - Street 1:5821 W MAPLE RD STE 195
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2275
Practice Address - Country:US
Practice Address - Phone:248-831-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2022-02-06
Deactivation Date:2021-12-30
Deactivation Code:
Reactivation Date:2022-02-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker