Healthcare Provider Details

I. General information

NPI: 1003035601
Provider Name (Legal Business Name): REBECCA FITTON LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ELMSHAVEN DR
LANSING MI
48917-3541
US

IV. Provider business mailing address

520 ELMSHAVEN DR
LANSING MI
48917-3541
US

V. Phone/Fax

Practice location:
  • Phone: 802-922-3848
  • Fax:
Mailing address:
  • Phone: 802-922-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0000706
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: