Provider Demographics
NPI:1356533707
Name:PITTS, LORI DANA (BA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:DANA
Last Name:PITTS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1878
Mailing Address - Country:US
Mailing Address - Phone:626-773-4364
Mailing Address - Fax:626-795-0979
Practice Address - Street 1:1963 N E ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3919
Practice Address - Country:US
Practice Address - Phone:909-881-6146
Practice Address - Fax:909-881-3479
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X, 171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)