Provider Demographics
NPI:1104472703
Name:FIELDS, AMBER NI'KOLE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NI'KOLE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6096 TEZCUCO CT
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8524
Mailing Address - Country:US
Mailing Address - Phone:225-978-9909
Mailing Address - Fax:
Practice Address - Street 1:1258 BROWNSWITCH RD STE CANDD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-1605
Practice Address - Country:US
Practice Address - Phone:985-661-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-11
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009481558106S00000X
171M00000X
LAPLC9618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator