Provider Demographics
NPI:1891539003
Name:FIELDS, CONSTANCE CHENELLE (APC)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:CHENELLE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 HAYNES TRACE CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2898
Mailing Address - Country:US
Mailing Address - Phone:352-214-8949
Mailing Address - Fax:
Practice Address - Street 1:4720 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:BLDG 400, STE 4201
Practice Address - City:BERKLEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:404-900-9583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008629101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health