Provider Demographics
NPI:1942611348
Name:PHILLIPS, DARNELL (MS, LPC)
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2468 CHEVIOT GLN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-1921
Mailing Address - Country:US
Mailing Address - Phone:615-414-5050
Mailing Address - Fax:404-910-4516
Practice Address - Street 1:2115 PIEDMONT RD NE
Practice Address - Street 2:3112
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4154
Practice Address - Country:US
Practice Address - Phone:615-414-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003984170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS