Active NPI
Michael Dale Fitzgerald Jr.
- Professional Counselor
- Rocky Mount, VA
National Provider Identifier
1619604758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0701013640
- Practice address
- 6934 Callaway Rd
Rocky Mount, VA 24151-4790 - Phone
- (540) 537-0025
- NPI assigned
- Aug 8, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701013640 | VA | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0710103168 | VA |
Addresses
Primary practice location
6934 Callaway Rd
Rocky Mount, VA 24151-4790
Mailing address
615 Elsinore PL Ste 200
Cincinnati, OH 45202-1457
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0710103168 | VA | MD | Addiction (Substance Use Disorder) Counselor |
| 0701013640 | VA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727308800000",
"number": "1619604758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 ELSINORE PL STE 200",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452021457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6934 CALLAWAY RD",
"city": "ROCKY MOUNT",
"state": "VA",
"postal_code": "241514790",
"telephone_number": "540-537-0025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZGERALD",
"first_name": "MICHAEL",
"middle_name": "DALE",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-08",
"last_updated": "2024-09-26",
"certification_date": "2024-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701013640",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "VA",
"license": "0710103168",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rocky Mount, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.