Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1378 | AL |
Y | 103T00000X | Psychologist | 1378 | AL |
NPI | 1013520204 |
---|---|
Provider Name | Tricia Witte |
First Address | Tuscaloosa, AL 35405-5420 |
Second Address | Tuscaloosa, AL 35405-5420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2020 |
Last Update Date | 26/08/2020 |