Provider Demographics
NPI:1467451427
Name:GUISTWITE, PHILIP T (MDIV MS)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:T
Last Name:GUISTWITE
Suffix:
Gender:M
Credentials:MDIV MS
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 489
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-0489
Mailing Address - Country:US
Mailing Address - Phone:910-897-8930
Mailing Address - Fax:910-897-8932
Practice Address - Street 1:400 DENIM DR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-2204
Practice Address - Country:US
Practice Address - Phone:910-897-8930
Practice Address - Fax:910-897-8932
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist