Provider Demographics
NPI:1174377725
Name:FISHER, JEAN B (MED, LCMHCA)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:B
Last Name:FISHER
Suffix:
Gender:F
Credentials:MED, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ABERSON CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8384
Mailing Address - Country:US
Mailing Address - Phone:708-606-8190
Mailing Address - Fax:
Practice Address - Street 1:120 TOWERVIEW CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3595
Practice Address - Country:US
Practice Address - Phone:919-585-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19865101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor