Provider Demographics
NPI:1316608524
Name:FISHER, ARDRENA EUGENEA
Entity type:Individual
Prefix:
First Name:ARDRENA
Middle Name:EUGENEA
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9099 MAIL SERVICE CTR # 2370
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-9000
Mailing Address - Country:US
Mailing Address - Phone:240-535-1222
Mailing Address - Fax:
Practice Address - Street 1:8352 SIX FORKS RD STE 210
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3054
Practice Address - Country:US
Practice Address - Phone:833-846-3463
Practice Address - Fax:855-510-6746
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0171071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical