Provider Demographics
NPI:1639892219
Name:PHILLIPS-MCNAMEE, DWAYNE ALVIN (LGSW, CFSW)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:ALVIN
Last Name:PHILLIPS-MCNAMEE
Suffix:
Gender:M
Credentials:LGSW, CFSW
Other - Prefix:
Other - First Name:DWAYNE
Other - Middle Name:ALVIN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4937 11TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2847
Mailing Address - Country:US
Mailing Address - Phone:347-304-7073
Mailing Address - Fax:
Practice Address - Street 1:4937 11TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2847
Practice Address - Country:US
Practice Address - Phone:347-304-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200002367104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker