Provider Demographics
NPI:1386698306
Name:LITWINS, NOLA (PHD)
Entity type:Individual
Prefix:
First Name:NOLA
Middle Name:
Last Name:LITWINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940165
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-0165
Mailing Address - Country:US
Mailing Address - Phone:972-849-4128
Mailing Address - Fax:469-342-8257
Practice Address - Street 1:12820 HILLCREST RD
Practice Address - Street 2:SUITE C107
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1526
Practice Address - Country:US
Practice Address - Phone:972-849-4128
Practice Address - Fax:469-342-8257
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0404089-02Medicaid
TX00464PMedicare PIN
TX0404089-02Medicaid