Provider Demographics
NPI:1255695862
Name:FIELDS, DAVID WAYNE (LCSW, CAP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:FIELDS
Suffix:
Gender:M
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SW 75TH ST APT E8
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1702
Mailing Address - Country:US
Mailing Address - Phone:352-256-3411
Mailing Address - Fax:
Practice Address - Street 1:15681 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:CITRA
Practice Address - State:FL
Practice Address - Zip Code:32113-3154
Practice Address - Country:US
Practice Address - Phone:352-595-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 98711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical