Provider Demographics
NPI:1205821188
Name:FITZGERALD, STACIE E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:E
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 1:1105 W. PEACHTREE STREET N.E.
Mailing Address - Street 2:FAMILIES FIRST
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-853-2811
Mailing Address - Fax:404-685-0204
Practice Address - Street 1:1105 W. PEACHTREE STREET N.E.
Practice Address - Street 2:FAMILIES FIRST
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-853-2811
Practice Address - Fax:404-685-0204
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069620-1 R1041C0700X
GACSW0026961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical