Provider Demographics
NPI:1699786475
Name:FISHER-TAYLOR, DEIDRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEIDRA
Middle Name:
Last Name:FISHER-TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEIDRA
Other - Middle Name:
Other - Last Name:FISHER-TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACSW
Mailing Address - Street 1:1139 SUGAR RUN RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-8232
Mailing Address - Country:US
Mailing Address - Phone:276-275-7201
Mailing Address - Fax:
Practice Address - Street 1:1139 SUGAR RUN RD
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263-8232
Practice Address - Country:US
Practice Address - Phone:276-273-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040029111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003760R99Medicare ID - Type Unspecified