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General NPI Number Information
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NPI Number | 1891539003
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Entity Type | Individual
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Provider Name | CONSTANCE CHENELLE FIELDS APC
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Gender | Female
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 4720 PEACHTREE INDUSTRIAL BLVD BLDG 400, STE 4201
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City | BERKLEY LAKE
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State | GA
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Zip | 30071
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Country | US
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Telephone | 404-900-9583
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Fax |
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Provider Business Mailing Address
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Address Line | 1435 HAYNES TRACE CT
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City | GRAYSON
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State | GA
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Zip | 30017-2898
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Country | US
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Telephone | 352-214-8949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APC008629
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License Number State | GA
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