MEDICARE: HOLLY W FITZGERALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C002252	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	2866729	OTHER	NC	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32276	OTHER	NC	BCBS PPO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1083697676	OTHER	NC	NPI

General Provider Information

NPI Number	:	1215984083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLY W FITZGERALD

Provider Business Mailing Address
First Line	:	213 OXFORD HILLS DR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-2131
Country	:	US
Telephone Number	:	919-942-4778
Fax Number	:	919-338-8044

Provider Business Practice Location Address
First Line	:	213 OXFORD HILLS DR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-2131
Country	:	US
Telephone Number	:	919-942-4778
Fax Number	:	919-338-8044

Authorized Official
Title or Position	:	MS.
Name	:	HOLLY W FITZGERALD
Credential	:	LCSW
Telephone Number	:	919-942-4778

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	11/09/2012

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