Provider Demographics
NPI:1689474652
Name:PITTMAN, ELMONISHA
Entity type:Individual
Prefix:
First Name:ELMONISHA
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S UNIVERSITY BLVD STE 2H
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-7860
Mailing Address - Country:US
Mailing Address - Phone:251-340-2020
Mailing Address - Fax:
Practice Address - Street 1:820 S UNIVERSITY BLVD STE 2H
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7860
Practice Address - Country:US
Practice Address - Phone:251-340-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-25-417853106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician