Provider Demographics
NPI:1639189566
Name:FIELDING, MICHAEL FRED (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRED
Last Name:FIELDING
Suffix:
Gender:M
Credentials:PHD
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 4168
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-8475
Mailing Address - Country:US
Mailing Address - Phone:804-530-1771
Mailing Address - Fax:804-530-1771
Practice Address - Street 1:4222 BONNIEBANK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-6602
Practice Address - Country:US
Practice Address - Phone:804-530-1771
Practice Address - Fax:804-530-1771
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000862103TC0700X
SC1025103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006420OtherBCBS BILLING #