Provider Demographics
NPI:1316273865
Name:FITZGERALD, DEBRA BOYDSTON (LPC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:BOYDSTON
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5118 PARK AVENUE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5714
Mailing Address - Country:US
Mailing Address - Phone:901-489-9921
Mailing Address - Fax:901-881-5428
Practice Address - Street 1:5118 PARK AVENUE
Practice Address - Street 2:SUITE 601
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5714
Practice Address - Country:US
Practice Address - Phone:901-489-9921
Practice Address - Fax:901-881-5428
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health