Individual
ALICE FITZGERALD
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
3008 BEVCHER DR, MADISON, IN 47250-3863
(812) 265-1918
(812) 378-8367
Mailing address
720 N MARR RD, COLUMBUS, IN 47201-6660
(812) 314-3400
(812) 378-8367
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39000794A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209803
ANTHEM PIN
IN
Enumeration date
02/02/2006
Last updated
07/08/2007
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