Provider Demographics
NPI:1396928735
Name:FISHELL, JARVIA LYNN (LCPC)
Entity type:Individual
Prefix:
First Name:JARVIA
Middle Name:LYNN
Last Name:FISHELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33108 LIGHTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-4018
Mailing Address - Country:US
Mailing Address - Phone:302-436-5247
Mailing Address - Fax:
Practice Address - Street 1:33108 LIGHTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-4018
Practice Address - Country:US
Practice Address - Phone:443-229-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0742101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259147-000OtherMAGELLAN BEHAVIORAL HEALTH
MD609550001Medicaid
MD7840093OtherAETNA
MDR968OtherCAREFIRST BCBS