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General NPI Number Information
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NPI Number | 1841923091
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Entity Type | Individual
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Provider Name | MARTHA LYNN FITZSIMON LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 8221 WILLOW OAKS CORPORATE DR
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City | FAIRFAX
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State | VA
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Zip | 22031-4512
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Country | US
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Telephone | 571-623-3529
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Fax |
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Provider Business Mailing Address
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Address Line | 10242 BRIGADE DR
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City | FAIRFAX
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State | VA
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Zip | 22030-2110
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Country | US
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Telephone | 703-850-6649
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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 | 0903002855
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License Number State | VA
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