Provider Demographics
NPI:1083806012
Name:FIELDS, JASON LEE (LPCI)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:FIELDS
Suffix:
Gender:M
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WHITEFORD CT STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7828
Mailing Address - Country:US
Mailing Address - Phone:803-808-1800
Mailing Address - Fax:803-808-1164
Practice Address - Street 1:130 WHITEFORD CT STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7828
Practice Address - Country:US
Practice Address - Phone:803-808-1800
Practice Address - Fax:803-808-1164
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional