Provider Demographics
NPI:1730238031
Name:FISHBACK, SARAH B (MA)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:B
Last Name:FISHBACK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 WENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-5546
Mailing Address - Country:US
Mailing Address - Phone:704-933-3505
Mailing Address - Fax:
Practice Address - Street 1:1605 OLD EARNHARDT RD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-8025
Practice Address - Country:US
Practice Address - Phone:704-933-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2309103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent