Provider Demographics
NPI:1972321305
Name:PITTMAN, MELANIE SIMONE (LCMHCA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:SIMONE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6600
Mailing Address - Country:US
Mailing Address - Phone:800-632-1400
Mailing Address - Fax:
Practice Address - Street 1:604 MEADOW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6600
Practice Address - Country:US
Practice Address - Phone:800-632-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20327101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health