Healthcare Provider Details

I. General information

NPI: 1811706369
Provider Name (Legal Business Name): NAKEYA FIELDS LICENSED CLINICAL SOCIAL WORKER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 6TH AVE
LOS ANGELES CA
90043-3263
US

IV. Provider business mailing address

530 S LAKE AVE STE 236
PASADENA CA
91101-3515
US

V. Phone/Fax

Practice location:
  • Phone: 213-394-5889
  • Fax: 213-723-2087
Mailing address:
  • Phone: 213-394-5889
  • Fax: 213-723-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NAKEYA FIELDS
Title or Position: CHIEF WELLNESS OFFICER
Credential: LCSW
Phone: 323-872-7634