Provider Demographics
NPI:1033997895
Name:PHIPPS, ANDREW JAY
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAY
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 N FRASER ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-6647
Mailing Address - Country:US
Mailing Address - Phone:843-240-2322
Mailing Address - Fax:
Practice Address - Street 1:525 LAFAYETTE CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2569
Practice Address - Country:US
Practice Address - Phone:843-240-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health