Healthcare Provider Details

I. General information

NPI: 1568868198
Provider Name (Legal Business Name): EUGENA FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 WESTGATE BLVD STE A
TACOMA WA
98406-2567
US

IV. Provider business mailing address

5410 N 44TH ST
TACOMA WA
98407-3715
US

V. Phone/Fax

Practice location:
  • Phone: 253-503-0226
  • Fax:
Mailing address:
  • Phone: 253-759-9954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: