Provider Demographics
NPI:1972828176
Name:PHILLIPS, ADRYANE (LPC)
Entity Type:Individual
Prefix:
First Name:ADRYANE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 REDAN TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2542
Mailing Address - Country:US
Mailing Address - Phone:770-378-8106
Mailing Address - Fax:404-745-8485
Practice Address - Street 1:3915 CASCADE RD SW
Practice Address - Street 2:SUITE 105
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8512
Practice Address - Country:US
Practice Address - Phone:678-973-2491
Practice Address - Fax:404-745-8485
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional