Provider Demographics
NPI:1295227304
Name:FISHER, SHENNA DOMINIQUE (LCSW-S)
Entity Type:Individual
Prefix:MRS
First Name:SHENNA
Middle Name:DOMINIQUE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 EXPO BLVD APT 1010
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1333
Mailing Address - Country:US
Mailing Address - Phone:210-643-4058
Mailing Address - Fax:866-544-0326
Practice Address - Street 1:7400 BLANCO RD STE 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4368
Practice Address - Country:US
Practice Address - Phone:210-643-4058
Practice Address - Fax:866-544-0326
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX575511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1003445818OtherGROUP NPI
TX1F6319Medicaid