Provider Demographics
NPI:1245865351
Name:FIELDS, SHARDAY A (LCSW)
Entity type:Individual
Prefix:
First Name:SHARDAY
Middle Name:A
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 1:650 PONCE DE LEON AVE NE
Mailing Address - Street 2:STE 300-1063
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1804
Mailing Address - Country:US
Mailing Address - Phone:404-290-1667
Mailing Address - Fax:
Practice Address - Street 1:650 PONCE DE LEON AVE NE
Practice Address - Street 2:STE 300-1063
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1804
Practice Address - Country:US
Practice Address - Phone:678-837-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007172101YM0800X
GALMSW104100000X
GACSW0077711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker