Individual
CHARLEEN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12812 101ST AVENUE CT E, PUYALLUP, WA 98373-9101
(253) 864-4770
(253) 864-4771
Mailing address
17210 91ST AVE E, PUYALLUP, WA 98375-2235
(253) 222-5012
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP 00004295
WA
101YM0800X
Mental Health Counselor
MC60323125
WA
Other
Enumeration date
09/25/2014
Last updated
09/25/2014
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