Provider Demographics
NPI:1043799794
Name:FIELDS, WENDELL HARRIS (CDCA 168492)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:HARRIS
Last Name:FIELDS
Suffix:
Gender:M
Credentials:CDCA 168492
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 EUCLID AVE STE 312
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2518
Mailing Address - Country:US
Mailing Address - Phone:216-712-2721
Mailing Address - Fax:
Practice Address - Street 1:3030 EUCLID AVE STE 312
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2518
Practice Address - Country:US
Practice Address - Phone:216-712-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165823101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)