Provider Demographics
NPI:1275938508
Name:FRITZ, PHILIP (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:FRITZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WINDCREST DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-0902
Mailing Address - Country:US
Mailing Address - Phone:347-543-2266
Mailing Address - Fax:
Practice Address - Street 1:39 WINDCREST DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-0902
Practice Address - Country:US
Practice Address - Phone:347-543-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health