Provider Demographics
NPI:1013726694
Name:PHIMMACHACK, PIPSMY ANGELA (EDD)
Entity type:Individual
Prefix:
First Name:PIPSMY
Middle Name:ANGELA
Last Name:PHIMMACHACK
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 E TRINDLE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3651
Mailing Address - Country:US
Mailing Address - Phone:717-857-6665
Mailing Address - Fax:887-371-4161
Practice Address - Street 1:5006 E TRINDLE RD STE 203
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3651
Practice Address - Country:US
Practice Address - Phone:717-857-6665
Practice Address - Fax:887-371-4161
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000765101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional