1124595152 NPI number — MRS. BRITTANY MARIE VITTOR LICSW

Table of content: MRS. BRITTANY MARIE VITTOR LICSW (NPI 1124595152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124595152 NPI number — MRS. BRITTANY MARIE VITTOR LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VITTOR
Provider First Name:
BRITTANY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

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:
1124595152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 SOTHEL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29651-2033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-717-5144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 SOUTHBRIDGE PKWY STE 650
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-717-5144
Provider Business Practice Location Address Fax Number:
929-596-7897
Provider Enumeration Date:
10/29/2018

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:  6671732 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 09931154 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 5979C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5979C . This is a "BOARD OF SOCIAL WORK EXAMINERS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 6671732 . This is a "BOARD OF SOCIAL WORK EXAMINERS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 09931154 . This is a "BOARD OF SOCIAL WORK EXAMINERS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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