Provider Demographics
NPI:1689995425
Name:PHILLIPS, CHARLETTA BORLAND (LPC)
Entity Type:Individual
Prefix:DR
First Name:CHARLETTA
Middle Name:BORLAND
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 WESSINGER RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8722
Mailing Address - Country:US
Mailing Address - Phone:336-312-0623
Mailing Address - Fax:
Practice Address - Street 1:3554 WESSINGER RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8722
Practice Address - Country:US
Practice Address - Phone:336-312-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional