Provider Demographics
NPI:1376229492
Name:FIELDS, KATIE BETH (RBT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:BETH
Last Name:FIELDS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:BETH
Other - Last Name:GARRIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 MARNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-8347
Mailing Address - Country:US
Mailing Address - Phone:704-640-6775
Mailing Address - Fax:
Practice Address - Street 1:128 FRANCES MEEKS WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3983
Practice Address - Country:US
Practice Address - Phone:912-445-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-280736106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician