Provider Demographics
NPI:1184975047
Name:FOLEY, PHYLLIS A (MED, MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:FOLEY
Suffix:
Gender:F
Credentials:MED, MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 E MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2645
Mailing Address - Country:US
Mailing Address - Phone:615-289-2918
Mailing Address - Fax:
Practice Address - Street 1:635 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2645
Practice Address - Country:US
Practice Address - Phone:615-289-2918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000543101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor