Provider Demographics
NPI:1508388018
Name:FLIPPEN, PHILLIP JAMARR (LMHP-R)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JAMARR
Last Name:FLIPPEN
Suffix:
Gender:M
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 MAYA LN
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:VA
Mailing Address - Zip Code:24586-2904
Mailing Address - Country:US
Mailing Address - Phone:434-630-8494
Mailing Address - Fax:888-767-7937
Practice Address - Street 1:278 MAYA LN
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:VA
Practice Address - Zip Code:24586-2904
Practice Address - Country:US
Practice Address - Phone:434-630-8494
Practice Address - Fax:888-767-7937
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA27-4726213Medicaid
VA1225570195Medicaid