MEDICARE: LASHAWN R. FISHER LPC

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	101Y00000X	Counselor	0701005399	VA
2	101Y00000X	Counselor	PRC14123	DC
3	101YM0800X	Mental Health Counselor	0701005399	VA
4	101YM0800X	Mental Health Counselor	PRC14123	DC
5	101YP2500X	Professional Counselor	0701005399	VA
6	101YP2500X	Professional Counselor	PRC14123	DC

General Provider Information

NPI Number	:	1336580224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHAWN R. FISHER LPC

Provider Business Mailing Address
First Line	:	505 POTOMAC HILLS DR
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7725
Country	:	US
Telephone Number	:	571-217-9463
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N WASHINGTON ST STE 102
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3441
Country	:	US
Telephone Number	:	571-217-9463
Fax Number	:

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

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	01/06/2014

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