Provider Demographics
NPI:1659918027
Name:PHILLIPS, DALISHA CHEREE (LMHCA, ATR-P)
Entity Type:Individual
Prefix:
First Name:DALISHA
Middle Name:CHEREE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMHCA, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BROADWAY E # 22111
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-7032
Mailing Address - Country:US
Mailing Address - Phone:253-260-6139
Mailing Address - Fax:
Practice Address - Street 1:1105 23RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4859
Practice Address - Country:US
Practice Address - Phone:253-260-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19-458221700000X
WAMHCA.MC.60914693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist