Provider Demographics
NPI:1144496100
Name:FIELDS, PEGGY G (MA COUNSELING)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:G
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:NC
Mailing Address - Zip Code:28438-0332
Mailing Address - Country:US
Mailing Address - Phone:910-648-2416
Mailing Address - Fax:
Practice Address - Street 1:1620 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3046
Practice Address - Country:US
Practice Address - Phone:843-488-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3612390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program