Healthcare Provider Details

I. General information

NPI: 1255045423
Provider Name (Legal Business Name): SHERROD FISHER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 RIVERSIDE DR STE 42
DANVILLE VA
24540-4267
US

IV. Provider business mailing address

2321 RIVERSIDE DR STE 42
DANVILLE VA
24540-4267
US

V. Phone/Fax

Practice location:
  • Phone: 434-354-2219
  • Fax: 434-354-2204
Mailing address:
  • Phone: 434-354-2219
  • Fax: 434-354-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701011558
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: