Provider Demographics
NPI:1093573628
Name:PHILLIPS, YAHMARI XAVIER (RBT)
Entity Type:Individual
Prefix:
First Name:YAHMARI
Middle Name:XAVIER
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 KENNYS ST
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-6445
Mailing Address - Country:US
Mailing Address - Phone:704-891-3214
Mailing Address - Fax:
Practice Address - Street 1:3125 KENNYS ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-6445
Practice Address - Country:US
Practice Address - Phone:704-891-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician