Provider Demographics
NPI:1255752952
Name:FISHER, VICKI GENELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:GENELLE
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 1:315 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-2049
Mailing Address - Country:US
Mailing Address - Phone:610-931-6243
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT ROAD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-417-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0171611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical