Provider Demographics
NPI:1144738642
Name:PHILLIPS, ERIN (CADC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12160 S UTAH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-9537
Mailing Address - Country:US
Mailing Address - Phone:563-326-1150
Mailing Address - Fax:563-333-9108
Practice Address - Street 1:12160 S UTAH AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-9537
Practice Address - Country:US
Practice Address - Phone:563-326-1150
Practice Address - Fax:563-333-9108
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17062101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)