Provider Demographics
NPI:1770114613
Name:FIELDING, LUCIEN (MA)
Entity type:Individual
Prefix:MS
First Name:LUCIEN
Middle Name:
Last Name:FIELDING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:LUCIE
Other - Middle Name:
Other - Last Name:FIELDING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:618 FOREST ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5267
Mailing Address - Country:US
Mailing Address - Phone:434-260-0317
Mailing Address - Fax:
Practice Address - Street 1:618 FOREST ST STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5267
Practice Address - Country:US
Practice Address - Phone:434-260-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704010558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty