Healthcare Provider Details

I. General information

NPI: 1861521643
Provider Name (Legal Business Name): BECKY J FIELDS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 DEER CREEK DR
CAPE CARTERET NC
28584-9702
US

IV. Provider business mailing address

511 DEER CREEK DR
CAPE CARTERET NC
28584-9702
US

V. Phone/Fax

Practice location:
  • Phone: 252-241-2126
  • Fax: 252-393-3377
Mailing address:
  • Phone: 252-241-2126
  • Fax: 252-393-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number461
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: