Provider Demographics
NPI:1811642028
Name:FIELDS, ISAIHA (RBT)
Entity type:Individual
Prefix:
First Name:ISAIHA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 JOHNSON FERRY RD STE 2170
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4948
Mailing Address - Country:US
Mailing Address - Phone:470-648-0510
Mailing Address - Fax:
Practice Address - Street 1:137 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4945
Practice Address - Country:US
Practice Address - Phone:470-648-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-203888106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician