Provider Demographics
NPI:1487172219
Name:FITZGERALD, WILLIAM HENRY III
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:FITZGERALD
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 TWO WOODS RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4445
Mailing Address - Country:US
Mailing Address - Phone:757-793-6381
Mailing Address - Fax:
Practice Address - Street 1:5163 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6501
Practice Address - Country:US
Practice Address - Phone:757-685-1384
Practice Address - Fax:757-685-1384
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician