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Individual

MRS. KIM MAXWELL FISH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW, LMHC

Contact information

Practice address
3948 NEW VISION DR STE D, FORT WAYNE, IN 46845-1721
(260) 407-7285
Mailing address
4903 COVENTRY PKWY, FORT WAYNE, IN 46804-7133
(419) 559-6370
(260) 407-0094

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39000977A
IN
1041C0700X
Clinical Social Worker
Primary
34004143A
IN
1041C0700X
Clinical Social Worker
I 0800371
OH

Other

Enumeration date
01/23/2007
Last updated
02/25/2011
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