Provider Demographics
NPI:1720430382
Name:FISH, RUFUS III (MA, LPCMHC, LCAS, NC)
Entity type:Individual
Prefix:MR
First Name:RUFUS
Middle Name:
Last Name:FISH
Suffix:III
Gender:
Credentials:MA, LPCMHC, LCAS, NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-6123
Mailing Address - Country:US
Mailing Address - Phone:336-601-5735
Mailing Address - Fax:
Practice Address - Street 1:1616 NORTH CAROLINA 68
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310
Practice Address - Country:US
Practice Address - Phone:336-252-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23557101YA0400X, 101YA0400X
NCS12058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health