Healthcare Provider Details

I. General information

NPI: 1548186554
Provider Name (Legal Business Name): MARLO R FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 LINCOLN DR APT 6B
SELMA AL
36701-6625
US

IV. Provider business mailing address

3100 LINCOLN DR APT 6B
SELMA AL
36701-6625
US

V. Phone/Fax

Practice location:
  • Phone: 334-413-0114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7785038
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: