Provider Demographics
NPI:1780708446
Name:FIELDS, LEONSHA' DAVON SR
Entity type:Individual
Prefix:MR
First Name:LEONSHA'
Middle Name:DAVON
Last Name:FIELDS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 MYRTLE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-8084
Mailing Address - Country:US
Mailing Address - Phone:310-671-0812
Mailing Address - Fax:
Practice Address - Street 1:822 MYRTLE AVE APT 2
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-8084
Practice Address - Country:US
Practice Address - Phone:310-671-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health