Provider Demographics
NPI:1861521643
Name:FIELDS, BECKY J (MA)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:J
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CAPE CARTERET
Mailing Address - State:NC
Mailing Address - Zip Code:28584-9702
Mailing Address - Country:US
Mailing Address - Phone:252-241-2126
Mailing Address - Fax:252-393-3377
Practice Address - Street 1:511 DEER CREEK DR
Practice Address - Street 2:
Practice Address - City:CAPE CARTERET
Practice Address - State:NC
Practice Address - Zip Code:28584-9702
Practice Address - Country:US
Practice Address - Phone:252-241-2126
Practice Address - Fax:252-393-3377
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC461103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107149Medicaid