Provider Demographics
NPI:1265985139
Name:PHILLIPS, ASHLEY-VICTORIA
Entity type:Individual
Prefix:
First Name:ASHLEY-VICTORIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 SOUTH RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4414
Mailing Address - Country:US
Mailing Address - Phone:860-245-1226
Mailing Address - Fax:203-303-9004
Practice Address - Street 1:174 SOUTH RD STE 301
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4414
Practice Address - Country:US
Practice Address - Phone:860-245-1226
Practice Address - Fax:203-303-9004
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist