Healthcare Provider Details

I. General information

NPI: 1144762287
Provider Name (Legal Business Name): KENNETH FIELDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W HOLMES RD
LANSING MI
48910-0426
US

IV. Provider business mailing address

502 W SPRING MEADOWS LN
DEWITT MI
48820-8750
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-4357
  • Fax: 517-272-4358
Mailing address:
  • Phone: 517-980-4970
  • Fax: 517-272-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: