Healthcare Provider Details

I. General information

NPI: 1740194752
Provider Name (Legal Business Name): CASSANDRA MONIQUE FISHER MH28555
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4608 CADEN PL
VALDOSTA GA
31601-5689
US

IV. Provider business mailing address

4608 CADEN PL
VALDOSTA GA
31601-5689
US

V. Phone/Fax

Practice location:
  • Phone: 386-792-6055
  • Fax:
Mailing address:
  • Phone: 386-792-6055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: