Provider Demographics
NPI:1003992702
Name:PHILLIPS, CINDY R (BSW)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FALLS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TORNADO
Mailing Address - State:WV
Mailing Address - Zip Code:25202-9533
Mailing Address - Country:US
Mailing Address - Phone:606-547-1027
Mailing Address - Fax:304-727-5340
Practice Address - Street 1:301 FALLS CREEK RD
Practice Address - Street 2:
Practice Address - City:TORNADO
Practice Address - State:WV
Practice Address - Zip Code:25202-9533
Practice Address - Country:US
Practice Address - Phone:606-547-1027
Practice Address - Fax:304-727-5340
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1709OtherPRIMARY SERVICE COORDINAT