Provider Demographics
NPI:1114272002
Name:FITZ-GERALD, SUNDARA AMBER LOTUS (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUNDARA
Middle Name:AMBER LOTUS
Last Name:FITZ-GERALD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2935
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-2935
Mailing Address - Country:US
Mailing Address - Phone:808-990-4605
Mailing Address - Fax:
Practice Address - Street 1:75-5744 ALII DR STE 237
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1740
Practice Address - Country:US
Practice Address - Phone:808-329-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILMFT- 464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist