Provider Demographics
NPI:1205144060
Name:FIELDS, SHARIYFA AZIYZA (LCSW)
Entity type:Individual
Prefix:
First Name:SHARIYFA
Middle Name:AZIYZA
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PHILADELPHIA PIKE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3166
Mailing Address - Country:US
Mailing Address - Phone:302-552-3574
Mailing Address - Fax:302-552-3561
Practice Address - Street 1:1624 JESSUP ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-4210
Practice Address - Country:US
Practice Address - Phone:302-552-3574
Practice Address - Fax:302-552-3561
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0001345101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)