Healthcare Provider Details

I. General information

NPI: 1275437782
Provider Name (Legal Business Name): NICOLE FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 STERLING RD STE 203
HERNDON VA
20170-3842
US

IV. Provider business mailing address

1043 STERLING RD STE 203
HERNDON VA
20170-3842
US

V. Phone/Fax

Practice location:
  • Phone: 513-314-9786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704018591
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: