Provider Demographics
NPI:1083109763
Name:FISCHER, TINA MARIE (CDCA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6086
Mailing Address - Country:US
Mailing Address - Phone:513-575-0968
Mailing Address - Fax:513-575-1019
Practice Address - Street 1:1569 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-6086
Practice Address - Country:US
Practice Address - Phone:513-575-0968
Practice Address - Fax:513-575-1019
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167515101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)