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NPI Code Detail

MEDICARE: MR. TYRONE JERROD FIELDS (TJ) NCCPSS, CADC-R

MEDICARE: MR. TYRONE JERROD FIELDS (TJ) NCCPSS, CADC-R
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCADC-28086NC

General Provider Information

NPI Number : 1063107472
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TYRONE JERROD FIELDS (TJ) NCCPSS, CADC-R
Provider Business Mailing Address
First Line : 7317 MELISSA CT
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28314-5814
Country : US
Telephone Number : 678-270-7112
Fax Number :
Provider Business Practice Location Address
First Line : 3427 MELROSE RD
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-1608
Country : US
Telephone Number : 910-864-8739
Fax Number : 910-864-8222
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2023
Last Update Date : 04/14/2023

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