Christina Madsen Fishback, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

0903002595 Issued in VA

Practice address

218 N Lee St Ste 201
Alexandria, VA 22314-2631

Phone

(831) 236-5801

Fax

(703) 842-8135

NPI assigned

Aug 3, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Old Town Psychotherapy

  • Community/Behavioral Health Agency
  • Alexandria, VA
  • NPI 1043898935
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1821576547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3388 WILTON CREST CT",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223102354",
            "telephone_number": "831-236-5801",
            "fax_number": "703-842-8135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 N LEE ST STE 201",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223142631",
            "telephone_number": "831-236-5801",
            "fax_number": "703-842-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHBACK",
        "first_name": "CHRISTINA",
        "middle_name": "MADSEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-03",
        "last_updated": "2021-06-09",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "VA",
            "license": "0903002595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS",
            "identifier": "0903002595",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "christina@awakenwellnesscenter.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "218 N Lee St Ste 201",
            "city": "Alexandria",
            "state": "VA",
            "country_code": "US",
            "postal_code": "223142631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Harold Fischer
• Sonja Fischer
• Wendy C Fischer, L.C.S.W.
• Mahlet Fiseha, LPN
• Hannah Fish, PHARMD
• Cierra Ann Fisher, LPCA
• Leon Fisher
• Simon Fishman, M.D.
• Lauren Fitchett
• Brianna Fitzgerald, RN

• Social Worker in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.