Provider Demographics
NPI:1245704691
Name:FITCH, AMELIA (MED, EDS)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:FITCH
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2120
Mailing Address - Country:US
Mailing Address - Phone:770-344-9205
Mailing Address - Fax:
Practice Address - Street 1:137 E WESTMONT AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-4847
Practice Address - Country:US
Practice Address - Phone:757-531-3039
Practice Address - Fax:757-531-3041
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool