Provider Demographics
NPI:1154567261
Name:FITTON, VICTORIA ANN (PHD, LMSW, ACSW)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ANN
Last Name:FITTON
Suffix:
Gender:F
Credentials:PHD, LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 ELMSHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-3541
Mailing Address - Country:US
Mailing Address - Phone:517-256-6167
Mailing Address - Fax:
Practice Address - Street 1:420 S WAVERLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-3632
Practice Address - Country:US
Practice Address - Phone:517-256-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010831231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008969970OtherBLUE CROSS/BLUE SHIELD/BLUE CARE NETWORK