Provider Demographics
NPI:1952135469
Name:FISHER, JAIMIE L (CATC I)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:L
Last Name:FISHER
Suffix:
Gender:F
Credentials:CATC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 MATCH POINT AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-2526
Mailing Address - Country:US
Mailing Address - Phone:707-615-2059
Mailing Address - Fax:
Practice Address - Street 1:2403 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3007
Practice Address - Country:US
Practice Address - Phone:707-615-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2314291101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)