Provider Demographics
NPI:1912003898
Name:FISHER, JUDITH V (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:V
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 BERRYMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7749
Mailing Address - Country:US
Mailing Address - Phone:919-644-0804
Mailing Address - Fax:919-644-0804
Practice Address - Street 1:109 MILLSTONE DR STE B
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8704
Practice Address - Country:US
Practice Address - Phone:919-664-0804
Practice Address - Fax:919-644-0804
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0044211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002639Medicaid
NC6002639Medicaid