Healthcare Provider Details

I. General information

NPI: 1831057595
Provider Name (Legal Business Name): FIELDWELL, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 PORTAGE BAY E STE 12
DAVIS CA
95616-3050
US

IV. Provider business mailing address

2659 PORTAGE BAY E STE 12
DAVIS CA
95616-3050
US

V. Phone/Fax

Practice location:
  • Phone: 916-258-2589
  • Fax:
Mailing address:
  • Phone: 916-258-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHARLES J MCNEIL
Title or Position: OWNER
Credential: LCSW
Phone: 916-258-2589