Provider Demographics
NPI:1962679506
Name:FITZSIMMONS, KATHLEEN ANN (PSYD LPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:PSYD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:DAHLGREN
Mailing Address - State:VA
Mailing Address - Zip Code:22448-0149
Mailing Address - Country:US
Mailing Address - Phone:540-663-0574
Mailing Address - Fax:540-663-0576
Practice Address - Street 1:5506 PAYNE DR
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485
Practice Address - Country:US
Practice Address - Phone:540-663-0574
Practice Address - Fax:540-663-0576
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional