Provider Demographics
NPI:1164867206
Name:PHILLIPS, SARAH GRACE (LAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GRACE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7107 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-2404
Mailing Address - Country:US
Mailing Address - Phone:501-613-1837
Mailing Address - Fax:
Practice Address - Street 1:7107 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2404
Practice Address - Country:US
Practice Address - Phone:501-613-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1204028101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor