Provider Demographics
NPI:1083146625
Name:FITZGERALD, COLLEEN
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 FLANDERS AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1135
Mailing Address - Country:US
Mailing Address - Phone:202-641-8113
Mailing Address - Fax:
Practice Address - Street 1:2639 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 251
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1537
Practice Address - Country:US
Practice Address - Phone:202-681-4374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00087101YP2500X
MDLGP6561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional