Provider Demographics
NPI:1558760793
Name:FISHBURN, DANIEL (LCSW, LCAS, MAC, CCS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FISHBURN
Suffix:
Gender:M
Credentials:LCSW, LCAS, MAC, CCS
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:B
Other - Last Name:FISHBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LCAS, MAC, CCS
Mailing Address - Street 1:65 MERRIMON AVE # 1028
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2322
Mailing Address - Country:US
Mailing Address - Phone:844-323-2675
Mailing Address - Fax:
Practice Address - Street 1:16 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2006
Practice Address - Country:US
Practice Address - Phone:828-333-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22491101YA0400X
NCC0092391041C0700X
CO099231481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)