Provider Demographics
NPI:1831852003
Name:FISHER, LISA M (LCPC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:FISHER
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 1:200 JUNEBERRY WAY UNIT 2A
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2321
Mailing Address - Country:US
Mailing Address - Phone:443-286-1763
Mailing Address - Fax:
Practice Address - Street 1:200 JUNEBERRY WAY UNIT 2A
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2321
Practice Address - Country:US
Practice Address - Phone:443-286-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC14272OtherMD BOARD OF PROFESSIONAL COUNSELORS AND THERAPISTS