Healthcare Provider Details

I. General information

NPI: 1134141492
Provider Name (Legal Business Name): WILLIE J FIELDS SR. MSSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

115 CANDLELIGHT LN
IRONDALE AL
35210
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8108
  • Fax: 205-939-4585
Mailing address:
  • Phone: 205-956-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0769-C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: