MEDICARE: MS. DIONE FIELDS LPC

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
1	101YP2500X	Professional Counselor	0701007613	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14263569	OTHER	VA	CAQH

General Provider Information

NPI Number	:	1497243489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIONE FIELDS LPC

Provider Business Mailing Address
First Line	:	221 RUTHERS RD STE 102
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5395
Country	:	US
Telephone Number	:	804-324-3780
Fax Number	:	804-729-9330

Provider Business Practice Location Address
First Line	:	221 RUTHERS RD STE 102
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5395
Country	:	US
Telephone Number	:	804-324-3780
Fax Number	:	804-729-9330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	06/12/2020

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