Healthcare Provider Details

I. General information

NPI: 1316473705
Provider Name (Legal Business Name): FRED JOSEPH FRITZ LPC, NCC, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 BRADFORD RD STE 102
VIRGINIA BEACH VA
23455-4021
US

IV. Provider business mailing address

616 CAREN DR
VIRGINIA BEACH VA
23452-3727
US

V. Phone/Fax

Practice location:
  • Phone: 757-453-2144
  • Fax:
Mailing address:
  • Phone: 757-635-9584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006933
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: