Provider Demographics
NPI:1134840127
Name:PHILLIP, NIZAE UNIQUE ELIZABETH (LCSWA)
Entity type:Individual
Prefix:
First Name:NIZAE
Middle Name:UNIQUE ELIZABETH
Last Name:PHILLIP
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E CORNWALLIS RD APT 1434A
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-3462
Mailing Address - Country:US
Mailing Address - Phone:910-232-7828
Mailing Address - Fax:
Practice Address - Street 1:249 NC-54
Practice Address - Street 2:# 320
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-907-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-10-24
Deactivation Date:2022-09-09
Deactivation Code:
Reactivation Date:2022-10-17
Provider Licenses
StateLicense IDTaxonomies
NCP0182191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical