Provider Demographics
NPI:1508469081
Name:PHILLIPS, CONSTANCE DENISE (MS, LCDC, CDVC)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:DENISE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, LCDC, CDVC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18711 ABIDING CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1915
Mailing Address - Country:US
Mailing Address - Phone:832-706-7364
Mailing Address - Fax:
Practice Address - Street 1:18711 ABIDING CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1915
Practice Address - Country:US
Practice Address - Phone:832-706-7364
Practice Address - Fax:832-201-0620
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8315101YA0400X
TX23679101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor