Individual
MICHAEL DALE FITZGERALD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6934 CALLAWAY RD, ROCKY MOUNT, VA 24151-4790
(540) 537-0025
Mailing address
615 ELSINORE PL STE 200, CINCINNATI, OH 45202-1457
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710103168
VA
101YP2500X
Professional Counselor
Primary
0701013640
VA
Other
Enumeration date
08/08/2022
Last updated
09/26/2024
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