Provider Demographics
NPI:1962481135
Name:PARRISH, PHYLLIS PETERSON (LCSW)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:PETERSON
Last Name:PARRISH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9740 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-2190
Mailing Address - Country:US
Mailing Address - Phone:910-276-2788
Mailing Address - Fax:910-276-4108
Practice Address - Street 1:227 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3831
Practice Address - Country:US
Practice Address - Phone:910-276-2788
Practice Address - Fax:910-276-4108
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0003931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002450Medicaid
NC65586OtherBLUE CROSS BLUE SHIELD
NC201035OtherCOMPSYCH
NC65586OtherBLUE CROSS BLUE SHIELD