Provider Demographics
NPI:1184159691
Name:FIELDS, NEEDHAM (LCAS-A)
Entity type:Individual
Prefix:MR
First Name:NEEDHAM
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 STATEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5425
Mailing Address - Country:US
Mailing Address - Phone:252-571-0983
Mailing Address - Fax:
Practice Address - Street 1:1430 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2002
Practice Address - Country:US
Practice Address - Phone:252-633-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-23
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor