Provider Demographics
NPI:1013792399
Name:PHILLIPS, ADDIS R
Entity Type:Individual
Prefix:MRS
First Name:ADDIS
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 S OAKLAND FOREST DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-7550
Mailing Address - Country:US
Mailing Address - Phone:786-444-0545
Mailing Address - Fax:
Practice Address - Street 1:2793 S OAKLAND FOREST DR
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-7550
Practice Address - Country:US
Practice Address - Phone:786-444-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health