Provider Demographics
NPI:1508462052
Name:MCKAIG-PHILLIPS, DENISE E (EDD, CRC, LRIC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:E
Last Name:MCKAIG-PHILLIPS
Suffix:
Gender:F
Credentials:EDD, CRC, LRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 DOLLIE MAE LN
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2931
Mailing Address - Country:US
Mailing Address - Phone:540-868-8424
Mailing Address - Fax:
Practice Address - Street 1:113 DOLLIE MAE LN
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2931
Practice Address - Country:US
Practice Address - Phone:540-868-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704006832101YP2500X
VAPPS-0602121101YS0200X
VA0715005529225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty