Healthcare Provider Details

I. General information

NPI: 1982152997
Provider Name (Legal Business Name): ANGELA FITCH MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E NORTHWEST HWY STE 212
PALATINE IL
60067-1700
US

IV. Provider business mailing address

16 ASCOT CIR
SCHAUMBURG IL
60194-3678
US

V. Phone/Fax

Practice location:
  • Phone: 847-584-2339
  • Fax:
Mailing address:
  • Phone: 630-886-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180010644
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.009559
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: