Provider Demographics
NPI:1487422952
Name:MUHAMMAD-PITTMAN, ASHANTI (LCPC)
Entity type:Individual
Prefix:
First Name:ASHANTI
Middle Name:
Last Name:MUHAMMAD-PITTMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 MACKLIND AVE UNIT 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3569
Mailing Address - Country:US
Mailing Address - Phone:618-705-0630
Mailing Address - Fax:
Practice Address - Street 1:807 W HIGHWAY 50 STE 3
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1856
Practice Address - Country:US
Practice Address - Phone:618-347-4129
Practice Address - Fax:618-247-4487
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015683101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health