Provider Demographics
NPI:1184946733
Name:ICARD, PHIL FRANKLIN II (PHD)
Entity type:Individual
Prefix:MR
First Name:PHIL
Middle Name:FRANKLIN
Last Name:ICARD
Suffix:II
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 1:344 ROLLING HILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6865
Mailing Address - Country:US
Mailing Address - Phone:704-662-5459
Mailing Address - Fax:704-663-2554
Practice Address - Street 1:344 ROLLING HILL RD STE 105
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-662-5459
Practice Address - Fax:704-663-2554
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3846103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist