Provider Demographics
NPI:1306583950
Name:FISHER, RELINDA VANDERWAL
Entity type:Individual
Prefix:
First Name:RELINDA
Middle Name:VANDERWAL
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27951 SMYTH DR STE 108
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4049
Mailing Address - Country:US
Mailing Address - Phone:661-607-6950
Mailing Address - Fax:
Practice Address - Street 1:27951 SMYTH DR STE 108
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4049
Practice Address - Country:US
Practice Address - Phone:661-607-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT41420106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist