Provider Demographics
NPI:1477794865
Name:FITZGERALD, KATHLEEN LOUISE (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DOGWOOD ACRES DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-3112
Mailing Address - Country:US
Mailing Address - Phone:919-933-8737
Mailing Address - Fax:
Practice Address - Street 1:1502 NC ROUTE 54
Practice Address - Street 2:SUITE 505
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1534
Practice Address - Country:US
Practice Address - Phone:919-933-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3926101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional