Provider Demographics
NPI:1447586326
Name:PHILLIPS, MEGAN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:7 LYNN PL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2104
Mailing Address - Country:US
Mailing Address - Phone:865-310-1039
Mailing Address - Fax:
Practice Address - Street 1:303 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2230
Practice Address - Country:US
Practice Address - Phone:865-310-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35011101YM0800X, 101YM0800X
DP009447291041C0700X
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner