Provider Demographics
NPI:1790014488
Name:PHILLIPS, AMY LYNN (LCPC, LMHC, EDD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCPC, LMHC, EDD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:AUGUST
Other - Last Name:CAHANIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, LMHC, EDD
Mailing Address - Street 1:6525 FARMINGDALE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1506
Mailing Address - Country:US
Mailing Address - Phone:301-755-9469
Mailing Address - Fax:
Practice Address - Street 1:6525 FARMINGDALE CT
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1506
Practice Address - Country:US
Practice Address - Phone:301-755-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD654736Medicaid