Provider Demographics
NPI:1023445939
Name:PHILLIP, CARLOS WILLIAM (EDD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:WILLIAM
Last Name:PHILLIP
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9312 OGDEN PL
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2774
Mailing Address - Country:US
Mailing Address - Phone:240-938-1175
Mailing Address - Fax:
Practice Address - Street 1:540 55TH STREET NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20019
Practice Address - Country:US
Practice Address - Phone:202-939-2030
Practice Address - Fax:240-485-0995
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool