Provider Demographics
NPI:1770639536
Name:PHILLIPS, PAULETTE (MSW)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 JUDGES DRIVES
Mailing Address - Street 2:P.O. BOX 598
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-0598
Mailing Address - Country:US
Mailing Address - Phone:276-926-4053
Mailing Address - Fax:
Practice Address - Street 1:133 MCCLURE AVE
Practice Address - Street 2:BOX 309
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-0309
Practice Address - Country:US
Practice Address - Phone:276-926-1680
Practice Address - Fax:276-926-7197
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator