Provider Demographics
NPI:1114340676
Name:FIELDS, TRACI-SHARA (LCSW-C, CCTP)
Entity Type:Individual
Prefix:
First Name:TRACI-SHARA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LCSW-C, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5229
Mailing Address - Country:US
Mailing Address - Phone:410-919-9587
Mailing Address - Fax:410-919-9588
Practice Address - Street 1:7025 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5229
Practice Address - Country:US
Practice Address - Phone:410-919-9587
Practice Address - Fax:410-919-9588
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17960104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker