Healthcare Provider Details

I. General information

NPI: 1902275449
Provider Name (Legal Business Name): FIELDS AND FIELDS TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MERCANTILE LN STE 221
LARGO MD
20774-5376
US

IV. Provider business mailing address

13602 GENTRY CT
MONTPELIER MD
20708-1330
US

V. Phone/Fax

Practice location:
  • Phone: 240-788-6125
  • Fax: 240-788-6156
Mailing address:
  • Phone: 240-788-6125
  • Fax: 240-788-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number1639
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1639
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CLIFFORD E FIELDS SR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 240-788-6125