Healthcare Provider Details

I. General information

NPI: 1174377725
Provider Name (Legal Business Name): JEAN B FISHER M.ED., LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 TOWERVIEW CT
CARY NC
27513-3595
US

IV. Provider business mailing address

2225 BLUE BAYOU BLVD
JOHNS ISLAND SC
29455-8383
US

V. Phone/Fax

Practice location:
  • Phone: 919-585-5085
  • Fax:
Mailing address:
  • Phone: 708-606-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19865
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12288
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: