Provider Demographics
NPI:1134627870
Name:DR. LAUREN FISHER, PSYD, PLLC
Entity type:Organization
Organization Name:DR. LAUREN FISHER, PSYD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-585-4809
Mailing Address - Street 1:2016 MOUNT VERNON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1366
Mailing Address - Country:US
Mailing Address - Phone:703-585-4809
Mailing Address - Fax:703-621-1128
Practice Address - Street 1:2016 MOUNT VERNON AVE STE 202
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-1366
Practice Address - Country:US
Practice Address - Phone:703-585-4809
Practice Address - Fax:703-621-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty