Provider Demographics
NPI:1164681128
Name:PHILLIPS, VANESSA RAE (MSW)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:RAE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37744-0188
Mailing Address - Country:US
Mailing Address - Phone:423-638-4171
Mailing Address - Fax:423-787-8797
Practice Address - Street 1:404 HOLSTON DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-3126
Practice Address - Country:US
Practice Address - Phone:423-638-4171
Practice Address - Fax:423-787-8797
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506510Medicaid