Provider Demographics
NPI:1720430382
Name:FISH, RUFUS III (MA, LPCMHC, LCAS, NC)
Entity Type:Individual
Prefix:MR
First Name:RUFUS
Middle Name:
Last Name:FISH
Suffix:III
Gender:M
Credentials:MA, LPCMHC, LCAS, NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 DUNSTAN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9565
Mailing Address - Country:US
Mailing Address - Phone:336-621-3381
Mailing Address - Fax:336-553-5046
Practice Address - Street 1:5140 DUNSTAN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-9565
Practice Address - Country:US
Practice Address - Phone:336-621-3381
Practice Address - Fax:336-553-5046
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12058101YM0800X
NCA12058101YP2500X
NC23557101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional