1548562069 NPI number — MR. DAVID GEORGE CHITTIM LICSW

Table of content: MR. DAVID GEORGE CHITTIM LICSW (NPI 1548562069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548562069 NPI number — MR. DAVID GEORGE CHITTIM LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHITTIM
Provider First Name:
DAVID
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548562069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4407 N DIVISION ST
Provider Second Line Business Mailing Address:
#304
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99207-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-324-3303
Provider Business Mailing Address Fax Number:
509-483-1876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4407 N DIVISION ST
Provider Second Line Business Practice Location Address:
#304
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-324-3303
Provider Business Practice Location Address Fax Number:
509-483-1876
Provider Enumeration Date:
12/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW 60153514 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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