Healthcare Provider Details

I. General information

NPI: 1346167780
Provider Name (Legal Business Name): MR. ALAN EDGAR FIELDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 FIELD ST
DETROIT MI
48214-1757
US

IV. Provider business mailing address

4590 MIDDLETON DR
WEST BLOOMFIELD MI
48323-3641
US

V. Phone/Fax

Practice location:
  • Phone: 313-731-2453
  • Fax:
Mailing address:
  • Phone: 248-770-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6851122298
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: