Individual
SHAVONDA LATRICE FIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1429 S KEDVALE AVE, CHICAGO, IL 60623-1246
(773) 680-0710
Mailing address
3473 S KING DR # 215, CHICAGO, IL 60616-4108
(773) 680-0710
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
—
172A00000X
Driver
Primary
F432-5915-7927
IL
251S00000X
Community/Behavioral Health Agency
—
—
347C00000X
Private Vehicle
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
10/05/2021
Last updated
10/05/2021
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