MEDICARE: CARLEY MARIE FISHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0904013631	VA

General Provider Information

NPI Number	:	1093536146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLEY MARIE FISHER

Provider Business Mailing Address
First Line	:	34 FAWN CT
Second Line	:
City	:	RUCKERSVILLE
State	:	VA
Zip	:	22968-9565
Country	:	US
Telephone Number	:	434-305-5202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 TERRACE GREENE CIR
Second Line	:
City	:	BARBOURSVILLE
State	:	VA
Zip	:	22923-2860
Country	:	US
Telephone Number	:	434-218-3562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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