Provider Demographics
NPI:1558046268
Name:PHILLIPS, AMANDA (LSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 COURTHOUSE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2450
Mailing Address - Country:US
Mailing Address - Phone:304-325-3378
Mailing Address - Fax:304-425-6980
Practice Address - Street 1:150 COURTHOUSE RD STE 301A
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-0059
Practice Address - Country:US
Practice Address - Phone:304-325-3378
Practice Address - Fax:304-425-6980
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker