Healthcare Provider Details

I. General information

NPI: 1720901283
Provider Name (Legal Business Name): EASTON VICTORIA FITZPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5013 WRIGHTSVILLE AVE
WILMINGTON NC
28403-7045
US

IV. Provider business mailing address

4405 COHAN CIR APT 103
WILMINGTON NC
28405-6507
US

V. Phone/Fax

Practice location:
  • Phone: 910-796-6868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22001
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: