Healthcare Provider Details

I. General information

NPI: 1477698090
Provider Name (Legal Business Name): RODERICK FIELDS CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RODERICK FIELDS CADC II

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 I STREET FREEDOM TO CHOOSE
DAVIS CA
95616
US

IV. Provider business mailing address

212 I STREET FREEDOM TO CHOOSE
DAVIS CA
95616
US

V. Phone/Fax

Practice location:
  • Phone: 530-601-5959
  • Fax:
Mailing address:
  • Phone: 530-601-5959
  • Fax: 916-484-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number124434
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA049760518
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: