Provider Demographics
NPI:1750915948
Name:FIELDS, JESSICA JOANNE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOANNE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 J N PEASE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4516
Mailing Address - Country:US
Mailing Address - Phone:980-981-1741
Mailing Address - Fax:
Practice Address - Street 1:1905 J N PEASE PL STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4516
Practice Address - Country:US
Practice Address - Phone:980-981-1741
Practice Address - Fax:980-321-7164
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15469101YM0800X
NC15469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health