Provider Demographics
NPI:1780962894
Name:FITZGERALD, JENNIFER CAROL (LLPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROL
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2749
Mailing Address - Country:US
Mailing Address - Phone:517-265-5352
Mailing Address - Fax:517-263-6090
Practice Address - Street 1:220 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2749
Practice Address - Country:US
Practice Address - Phone:517-265-5352
Practice Address - Fax:517-263-6090
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional