Provider Demographics
NPI:1295199222
Name:CASBY, PHILLIP (LICDC-CS, SAP)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:CASBY
Suffix:
Gender:M
Credentials:LICDC-CS, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 MEGGIN MELANNE LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1779
Mailing Address - Country:US
Mailing Address - Phone:740-973-5447
Mailing Address - Fax:
Practice Address - Street 1:62 E STEVENS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5969
Practice Address - Country:US
Practice Address - Phone:740-366-7303
Practice Address - Fax:740-366-7305
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH923231101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)