Provider Demographics
NPI:1689900326
Name:FISHER, KATHY CRUSE (LPC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:CRUSE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 N HIGHWAY 16 STE 103
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7315
Mailing Address - Country:US
Mailing Address - Phone:469-323-7292
Mailing Address - Fax:
Practice Address - Street 1:3140 N HIGHWAY 16 STE 103
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7315
Practice Address - Country:US
Practice Address - Phone:469-323-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-01
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7517101YP2500X
NC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool