Healthcare Provider Details

I. General information

NPI: 1548935505
Provider Name (Legal Business Name): CHRISTINA NICHOLE FIELDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 JENNIFER RD
ANNAPOLIS MD
21401-3064
US

IV. Provider business mailing address

917 RUSSELL RD
EVERMAN TX
76140-3735
US

V. Phone/Fax

Practice location:
  • Phone: 443-291-8090
  • Fax:
Mailing address:
  • Phone: 903-375-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119755
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27783
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: