Healthcare Provider Details

I. General information

NPI: 1104472703
Provider Name (Legal Business Name): AMBER NI'KOLE FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 BROWNSWITCH RD STE CANDD
SLIDELL LA
70461-1605
US

IV. Provider business mailing address

6096 TEZCUCO CT
GONZALES LA
70737-8524
US

V. Phone/Fax

Practice location:
  • Phone: 985-661-0560
  • Fax:
Mailing address:
  • Phone: 225-978-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC9618
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9618
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number009481558
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: