Provider Demographics
NPI:1689808404
Name:FIELDS POLK, ZELDA (MA)
Entity Type:Individual
Prefix:MRS
First Name:ZELDA
Middle Name:
Last Name:FIELDS POLK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N LAKEMONT AVE
Mailing Address - Street 2:STE B
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3205
Mailing Address - Country:US
Mailing Address - Phone:407-830-6412
Mailing Address - Fax:407-830-8413
Practice Address - Street 1:315 N LAKEMONT AVE
Practice Address - Street 2:STE B
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3205
Practice Address - Country:US
Practice Address - Phone:407-830-6412
Practice Address - Fax:407-830-8413
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH4695101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor