Provider Demographics
NPI:1922334416
Name:FITCH, JILLIAN (MA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:FITCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W LOCKHAVEN DR
Mailing Address - Street 2:APT G
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1689
Mailing Address - Country:US
Mailing Address - Phone:585-322-3962
Mailing Address - Fax:
Practice Address - Street 1:2719 GRAVES DR STE 7
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4536
Practice Address - Country:US
Practice Address - Phone:919-583-8448
Practice Address - Fax:919-583-8449
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3838103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical