Provider Demographics
NPI:1588343206
Name:PITTMAN, KIMIKO J (LCSW-A, LCAS-A)
Entity type:Individual
Prefix:
First Name:KIMIKO
Middle Name:J
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LCSW-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 DRIVERS CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-9614
Mailing Address - Country:US
Mailing Address - Phone:252-325-3207
Mailing Address - Fax:
Practice Address - Street 1:1216 DRIVERS CIR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9614
Practice Address - Country:US
Practice Address - Phone:252-325-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29090101YA0400X
NCP0192971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)