Provider Demographics
NPI:1871277236
Name:FIELDS, CHARLENE (LPC, CRC, LADAC)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LPC, CRC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3942 E MONITOR RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-2602
Practice Address - Country:US
Practice Address - Phone:479-295-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
324500000X
ARP2310012101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility