Provider Demographics
NPI:1508151846
Name:FITTS, ANGELA DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DIANE
Last Name:FITTS
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 1:1097 DORADO DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7086
Mailing Address - Country:US
Mailing Address - Phone:407-408-4800
Mailing Address - Fax:
Practice Address - Street 1:1750 TREE BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5715
Practice Address - Country:US
Practice Address - Phone:904-342-0672
Practice Address - Fax:904-342-0673
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW96081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical