Provider Demographics
NPI:1184693699
Name:PHILLIPS, ROBERT DEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 MILMONT SHORES RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9559
Mailing Address - Country:US
Mailing Address - Phone:803-360-9698
Mailing Address - Fax:803-941-7266
Practice Address - Street 1:152 MILMONT SHORES RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9559
Practice Address - Country:US
Practice Address - Phone:803-360-9698
Practice Address - Fax:803-941-7266
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC410103TC0700X, 103TC2200X, 103TE1100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3921Medicaid
SCPS0387Medicaid
SCGP3921Medicaid
SCPS0387Medicaid
SCQ336950282Medicare PIN