MEDICARE: NICOLE FISHER LCPC

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	LC6295	MD

General Provider Information

NPI Number	:	1720467095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE FISHER LCPC

Provider Business Mailing Address
First Line	:	1208 E CHURCHVILLE RD
Second Line	:	STE 300
City	:	BEL AIR
State	:	MD
Zip	:	21014-3442
Country	:	US
Telephone Number	:	410-776-3187
Fax Number	:	443-640-4358

Provider Business Practice Location Address
First Line	:	8007 CORPORATE DR
Second Line	:	STE C
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-4905
Country	:	US
Telephone Number	:	410-776-3187
Fax Number	:	443-640-4358

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

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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