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General NPI Number Information
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NPI Number | 1780214460
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Entity Type | Individual
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Provider Name | ANGELA W FITZGERALD
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Gender | Female
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 2205 PERL RD
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City | RICHMOND
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State | VA
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Zip | 23230-2007
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Country | US
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Telephone | 804-447-2139
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Fax | 804-447-2156
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Provider Business Mailing Address
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Address Line | 3126 W CARY ST APT 262
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City | RICHMOND
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State | VA
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Zip | 23221-3504
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Country | US
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Telephone | 804-908-1115
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0733007192
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0732001118
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License Number State | VA
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