Provider Demographics
NPI:1972801538
Name:FISK, ALENE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALENE
Middle Name:W
Last Name:FISK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 NORTHEAST DR
Mailing Address - Street 2:SUITE 19
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7430
Mailing Address - Country:US
Mailing Address - Phone:704-661-9346
Mailing Address - Fax:
Practice Address - Street 1:709 NORTHEAST DR
Practice Address - Street 2:SUITE 19
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7430
Practice Address - Country:US
Practice Address - Phone:704-661-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3387103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical