Organization
STRUCTURES YOUTH HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN ANN FITZSIMMONS PSY.D (CAO/CLINICAL DIRECTOR)
(540) 663-0574
Entity
Organization
Contact information
Practice address
646 HOLLY CORNER RD, FREDERICKSBURG, VA 22406-5308
(540) 752-0013
(540) 752-1147
Mailing address
PO BOX 149, DAHLGREN, VA 22448-0149
(540) 663-0574
(540) 663-0576
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
SS-149-05
VA
Other
Enumeration date
06/09/2008
Last updated
06/09/2008
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