Provider Demographics
NPI:1518454545
Name:PHAN, CAROLINE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:PHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 OLD KEENE MILL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2352
Mailing Address - Country:US
Mailing Address - Phone:202-360-1113
Mailing Address - Fax:
Practice Address - Street 1:6207 OLD KEENE MILL CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2352
Practice Address - Country:US
Practice Address - Phone:202-360-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool