Provider Demographics
NPI:1922465707
Name:LOUIS, PHILLIPPE (MS, NCC, APC, CAMS-2)
Entity Type:Individual
Prefix:MR
First Name:PHILLIPPE
Middle Name:
Last Name:LOUIS
Suffix:
Gender:M
Credentials:MS, NCC, APC, CAMS-2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 GARDEN WOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-6285
Mailing Address - Country:US
Mailing Address - Phone:786-547-0519
Mailing Address - Fax:
Practice Address - Street 1:1515 GARDEN WOOD DR
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-6285
Practice Address - Country:US
Practice Address - Phone:786-547-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAPC004975Medicaid