Provider Demographics
NPI:1124178579
Name:D'AGOSTINO, PHILIP LEE (MED)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:LEE
Last Name:D'AGOSTINO
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5522 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8706
Mailing Address - Country:US
Mailing Address - Phone:919-341-8431
Mailing Address - Fax:
Practice Address - Street 1:5522 STRATHMORE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-8706
Practice Address - Country:US
Practice Address - Phone:919-341-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional