Healthcare Provider Details

I. General information

NPI: 1629503248
Provider Name (Legal Business Name): LARRY MICHAEL FIELDS M.S., L.P.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 WHITE OAK LN
DECATUR GA
30032-5510
US

IV. Provider business mailing address

2801 WHITE OAK LN
DECATUR GA
30032-5510
US

V. Phone/Fax

Practice location:
  • Phone: 770-842-5083
  • Fax: 208-439-9293
Mailing address:
  • Phone: 770-842-5083
  • Fax: 208-439-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC007196
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC007196
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007196
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: