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General NPI Number Information
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NPI Number | 1952659989
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Entity Type | Organization
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Legal Business Name | GATEWAY COUNSELING CENTER
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Dates
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Enumeration Date | 08/23/2012
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 5506 PAYNE DR
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City | KING GEORGE
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State | VA
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Zip | 22485-6213
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Country | US
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Telephone | 540-663-0574
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Fax | 540-663-0576
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Provider Business Mailing Address
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Address Line | PO BOX 149
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City | DAHLGREN
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State | VA
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Zip | 22448-0149
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Country | US
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Telephone | 540-663-0574
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Fax | 540-663-0576
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHLEEN FITZSIMMONS
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Credential | PSYD, LPC
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Telephone | 540-663-0574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101050361
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003741
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License Number State | VA
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