Provider Demographics
NPI:1144798810
Name:FITZPATRICK, RASHAWNDA TERAY
Entity Type:Individual
Prefix:
First Name:RASHAWNDA
Middle Name:TERAY
Last Name:FITZPATRICK
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 1:7310 WOODWARD AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3165
Mailing Address - Country:US
Mailing Address - Phone:313-896-1444
Mailing Address - Fax:
Practice Address - Street 1:7310 WOODWARD AVE STE 601
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3165
Practice Address - Country:US
Practice Address - Phone:313-896-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2022-12-06
Deactivation Date:2022-11-04
Deactivation Code:
Reactivation Date:2022-11-16
Provider Licenses
StateLicense IDTaxonomies
MI6451022289101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144798810Medicaid