Provider Demographics
NPI:1922786276
Name:PHILLIPS, ARDENESIA
Entity Type:Individual
Prefix:
First Name:ARDENESIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DUNBAR CAVE RD STE A&B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8862
Mailing Address - Country:US
Mailing Address - Phone:985-634-0615
Mailing Address - Fax:
Practice Address - Street 1:120 DUNBAR CAVE RD STE A&B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8862
Practice Address - Country:US
Practice Address - Phone:985-634-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician