Provider Demographics
NPI:1942721485
Name:PHILLIPS, GREGORY NEILL (LCSWA, LCASA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:NEILL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5579 HALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2864
Mailing Address - Country:US
Mailing Address - Phone:910-689-5621
Mailing Address - Fax:
Practice Address - Street 1:1014 HAY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5316
Practice Address - Country:US
Practice Address - Phone:910-500-3046
Practice Address - Fax:910-900-3100
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23146101YA0400X
NCPO12034101YM0800X
NCP016042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)