Doctor Name: | MRS. BRENDA SHARALYN FISHER |
NPI Number: | 1265433411 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LCAS LPC LPC-S |
License Number: | 4124 |
Business Practice Address: | 4320 Southport Supply Rd Se Suite 300 Southport, NC - 284618158 |
Business Phone Number: | 9109643352 |
Business Fax Number: | 9108423351 |
Mailing Address: | 428 Hamilton Dr Se, BOLIVIA |
State: | NC |
Postal Code: | 284227716 |
Phone Number: | 9109643352 |
Fax Number: | 9108423351 |
NPI Enumeration Date: | 08/09/2005 |
NPI Last Update Date: | 09/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 4124 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |