Provider Demographics
NPI:1508031618
Name:FITZHUGH, ROSA (LPC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:FITZHUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 AUTUMN LAKE LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3582
Mailing Address - Country:US
Mailing Address - Phone:404-503-5752
Mailing Address - Fax:
Practice Address - Street 1:2696 AUTUMN LAKE LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3582
Practice Address - Country:US
Practice Address - Phone:404-503-5752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 006300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional