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General NPI Number Information
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NPI Number | 1104435718
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Entity Type | Individual
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Provider Name | VINCENT MICHAEL FITCH PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 1 FREEDOM WAY
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City | AUGUSTA
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State | GA
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Zip | 30904-6258
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Country | US
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Telephone | 443-542-7387
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Fax |
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Provider Business Mailing Address
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Address Line | 529 W BUENA VISTA AVE
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-3639
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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