Provider Demographics
NPI:1578945606
Name:PHILLIPS, SAMATRA L (MA, MAC, ICAADC, CPR)
Entity Type:Individual
Prefix:MS
First Name:SAMATRA
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, MAC, ICAADC, CPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4868 OZMENT TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6208
Mailing Address - Country:US
Mailing Address - Phone:404-838-1271
Mailing Address - Fax:
Practice Address - Street 1:6800 DAHLONEGA HWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-5595
Practice Address - Country:US
Practice Address - Phone:404-838-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor