Provider Demographics
NPI:1659718757
Name:FISH, L'TANYA THERESE (MS, CRC, LPCA)
Entity Type:Individual
Prefix:MISS
First Name:L'TANYA
Middle Name:THERESE
Last Name:FISH
Suffix:
Gender:F
Credentials:MS, CRC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BEDFORDSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3772
Mailing Address - Country:US
Mailing Address - Phone:919-818-5474
Mailing Address - Fax:919-876-5492
Practice Address - Street 1:2801 BEDFORDSHIRE CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3772
Practice Address - Country:US
Practice Address - Phone:919-818-5474
Practice Address - Fax:919-876-5492
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPCA #7652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health