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General NPI Number Information
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NPI Number | 1366192452
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Entity Type | Individual
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Provider Name | MICHAEL JACOB FISHER CSAC-S,
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Gender | Male
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 3208 HERSHBERGER RD NW
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City | ROANOKE
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State | VA
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Zip | 24017-1842
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Country | US
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Telephone | 540-202-2402
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Fax | 540-563-3084
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Provider Business Mailing Address
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Address Line | 2306 LONGVIEW AVE SW
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City | ROANOKE
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State | VA
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Zip | 24014-1614
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Country | US
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Telephone | 603-978-9032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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