Provider Demographics
NPI:1225345689
Name:PHILLIPS, STEPHANIE DAWN (MED, LPC, NCC,CCTP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DAWN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MED, LPC, NCC,CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 SIX FORKS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3074
Mailing Address - Country:US
Mailing Address - Phone:919-617-9656
Mailing Address - Fax:919-617-9656
Practice Address - Street 1:8406 SIX FORKS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3074
Practice Address - Country:US
Practice Address - Phone:919-617-9656
Practice Address - Fax:919-617-9656
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2303373OtherCOMPSYCH
NC12360850OtherBCBS NC
NC6104904Medicaid
NC$$$$$$$$$OtherTRICARE