1558760793 NPI number — DANIEL FISHBURN LCSW, LCAS, MAC, CCS

Table of content: DANIEL FISHBURN LCSW, LCAS, MAC, CCS (NPI 1558760793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558760793 NPI number — DANIEL FISHBURN LCSW, LCAS, MAC, CCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHBURN
Provider First Name:
DANIEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LCAS, MAC, CCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISHBURN
Provider Other First Name:
DANIEL
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, LCAS, MAC, CCS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1558760793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 MERRIMON AVE # 1028
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28801-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-323-2675
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 ARLINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-333-9739
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LCAS-22491 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C009239 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)