Provider Demographics
NPI:1255704532
Name:FISHER, VICTORIA (LMSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 E BELTLINE AVE NE STE 106-812
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7045
Mailing Address - Country:US
Mailing Address - Phone:616-259-6227
Mailing Address - Fax:
Practice Address - Street 1:1121 BROADWAY AVE NW APT 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4215
Practice Address - Country:US
Practice Address - Phone:517-677-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010989981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical