Provider Demographics
NPI:1487736807
Name:MAYO-PITTS, REBECCA K (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:MAYO-PITTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 RIVANNA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FORK UNION
Mailing Address - State:VA
Mailing Address - Zip Code:23055-2129
Mailing Address - Country:US
Mailing Address - Phone:434-825-8069
Mailing Address - Fax:434-842-1110
Practice Address - Street 1:4064 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:FORK UNION
Practice Address - State:VA
Practice Address - Zip Code:23055
Practice Address - Country:US
Practice Address - Phone:434-825-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040051681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008939489Medicaid
VA008939489Medicaid