Provider Demographics
NPI:1669679163
Name:FISHER, KATRINA (LCSW)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:FISHER
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2544 COLTSGATE RD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8274
Mailing Address - Country:US
Mailing Address - Phone:704-243-3412
Mailing Address - Fax:704-243-1678
Practice Address - Street 1:400 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4804
Practice Address - Country:US
Practice Address - Phone:704-296-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0039941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142F6OtherBCBS
NC6106825Medicaid
NC6106825Medicaid