Provider Demographics
NPI:1356713838
Name:FIELDS-WRIGHT, PATRICIA A (MS,LPCC, LICDC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:FIELDS-WRIGHT
Suffix:
Gender:F
Credentials:MS,LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 KETTERING BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1983
Mailing Address - Country:US
Mailing Address - Phone:937-293-8300
Mailing Address - Fax:
Practice Address - Street 1:3095 KETTERING BLVD FL 4
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1983
Practice Address - Country:US
Practice Address - Phone:937-293-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.991516101YA0400X
OH991516101YA0400X
OHICDC991516I101YA0400X
OHC1300406101YM0800X
OHE.2202721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health