Provider Demographics
NPI:1154126340
Name:FIELDS, DEVIONNE MIKEL (LCMHCA)
Entity type:Individual
Prefix:
First Name:DEVIONNE
Middle Name:MIKEL
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 BANNINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1341
Mailing Address - Country:US
Mailing Address - Phone:704-533-5810
Mailing Address - Fax:
Practice Address - Street 1:6419 BANNINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1341
Practice Address - Country:US
Practice Address - Phone:704-533-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health