Provider Demographics
NPI:1578229431
Name:FISHER, PORSCHIA TIAJUANA (ALC)
Entity Type:Individual
Prefix:MS
First Name:PORSCHIA
Middle Name:TIAJUANA
Last Name:FISHER
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-2632
Mailing Address - Country:US
Mailing Address - Phone:205-704-2686
Mailing Address - Fax:
Practice Address - Street 1:1345 WESTMINSTER PL
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-2632
Practice Address - Country:US
Practice Address - Phone:205-704-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2340A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional