Provider Demographics
NPI:1952749921
Name:FISHER, DIEDRE MONIQUE (LCASA)
Entity Type:Individual
Prefix:
First Name:DIEDRE
Middle Name:MONIQUE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BILLINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1002
Mailing Address - Country:US
Mailing Address - Phone:704-927-8798
Mailing Address - Fax:704-376-3384
Practice Address - Street 1:300 MOORESVILLE RD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-0304
Practice Address - Country:US
Practice Address - Phone:704-920-1205
Practice Address - Fax:704-934-4270
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3352101YA0400X, 101Y00000X
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor