Doctor Name: | MARY DORIS FITZGERALD |
NPI Number: | 1124395306 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 802 |
Business Practice Address: | 2130 Lawson Creek Rd Douglas, AK - 998245010 |
Business Phone Number: | 8018604439 |
Business Fax Number: | |
Mailing Address: | 2130 Lawson Creek Rd, DOUGLAS |
State: | AK |
Postal Code: | 998245010 |
Phone Number: | 8018604439 |
Fax Number: | |
NPI Enumeration Date: | 11/16/2011 |
NPI Last Update Date: | 10/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 802 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |