Individual
DACIA LEE ANTISTE-FISHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5 4TH AVE E, POLSON, MT 59860-2117
(406) 745-3525
(406) 745-3529
Mailing address
P.O. BOX 880, ST. IGNATIUS, MT 59865
(406) 745-3525
(406) 745-3529
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1930
MT
101YA0400X
Addiction (Substance Use Disorder) Counselor
LAC-LAC-LIC-1930
MT
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-30076
MT
Other
Enumeration date
11/05/2013
Last updated
03/14/2024
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