Provider Demographics
NPI:1043871734
Name:FITCH, KRISTINA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:FITCH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1872
Mailing Address - Country:US
Mailing Address - Phone:203-738-9306
Mailing Address - Fax:
Practice Address - Street 1:1205 DURHAM RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-1872
Practice Address - Country:US
Practice Address - Phone:203-738-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional