Basic Information
| Provider Information | |||||||||
| NPI: | 1013900042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIELDS | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 699 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376840699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397280 | ||||||||
| FaxNumber: | 4234397314 | ||||||||
| Practice Location | |||||||||
| Address1: | 329 N STATE OF FRANKLIN RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397280 | ||||||||
| FaxNumber: | 4234397314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 02/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LSW3396 | TN | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LSW3396 | TN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.