Provider Demographics
NPI:1215984083
Name:HOLLY W FITZGERALD
Entity type:Organization
Organization Name:HOLLY W FITZGERALD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS.
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-942-4778
Mailing Address - Street 1:213 OXFORD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2131
Mailing Address - Country:US
Mailing Address - Phone:919-942-4778
Mailing Address - Fax:919-338-8044
Practice Address - Street 1:213 OXFORD HILLS DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2131
Practice Address - Country:US
Practice Address - Phone:919-942-4778
Practice Address - Fax:919-338-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC32276OtherBCBS PPO
NC6002883Medicaid
NC1083697676OtherNPI
NC2866729OtherMEDICARE