Provider Demographics
NPI:1083697676
Name:FITZGERALD, HOLLY W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:W
Last Name:FITZGERALD
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 1:213 OXFORD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2131
Mailing Address - Country:US
Mailing Address - Phone:919-942-4778
Mailing Address - Fax:919-338-8044
Practice Address - Street 1:213 OXFORD HILLS DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2131
Practice Address - Country:US
Practice Address - Phone:919-942-4778
Practice Address - Fax:919-932-3007
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO2252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC32276OtherBCBS
NC6002883Medicaid
NC6002883Medicaid