Provider Demographics
NPI:1598370587
Name:JOHNSON FIELDS, CAROLYN JEAN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JEAN
Last Name:JOHNSON FIELDS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BERMUDA LN
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75803-5435
Mailing Address - Country:US
Mailing Address - Phone:903-922-1725
Mailing Address - Fax:
Practice Address - Street 1:118 BERMUDA LN
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75803-5435
Practice Address - Country:US
Practice Address - Phone:903-922-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79323101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional