Healthcare Provider Details

I. General information

NPI: 1154567261
Provider Name (Legal Business Name): VICTORIA ANN FITTON PHD, LMSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S WAVERLY RD
LANSING MI
48917-3632
US

IV. Provider business mailing address

520 ELMSHAVEN DR
LANSING MI
48917-3541
US

V. Phone/Fax

Practice location:
  • Phone: 517-256-6167
  • Fax:
Mailing address:
  • Phone: 517-256-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801083123
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: