Provider Demographics
NPI:1487819207
Name:PHILLIPS, RICHARD LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 OVERLOOK CRST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8476
Mailing Address - Country:US
Mailing Address - Phone:770-267-0706
Mailing Address - Fax:
Practice Address - Street 1:204 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1914
Practice Address - Country:US
Practice Address - Phone:678-509-7178
Practice Address - Fax:866-734-7631
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0037521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical