Provider Demographics
NPI:1134724032
Name:PHILLIPS, CASSANDRA (LCMHCA, LCASA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCMHCA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5167 DENTON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NC
Mailing Address - Zip Code:27557-8554
Mailing Address - Country:US
Mailing Address - Phone:614-843-0564
Mailing Address - Fax:
Practice Address - Street 1:3012 FALSTAFF RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1813
Practice Address - Country:US
Practice Address - Phone:919-615-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health