Provider Demographics
NPI:1114295730
Name:FIELD, CAROL SOPHIA
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SOPHIA
Last Name:FIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0256
Mailing Address - Country:US
Mailing Address - Phone:907-442-7640
Mailing Address - Fax:907-442-7749
Practice Address - Street 1:1897 TUNDRA WAY
Practice Address - Street 2:BOX 189
Practice Address - City:NOORVIK
Practice Address - State:AK
Practice Address - Zip Code:99763-0189
Practice Address - Country:US
Practice Address - Phone:907-636-2103
Practice Address - Fax:907-636-2195
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10-1058-III172V00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker