Provider Demographics
NPI:1497599526
Name:TOTISHA L. PHELPS LLC
Entity type:Organization
Organization Name:TOTISHA L. PHELPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOTISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:CPSS/COACH
Authorized Official - Phone:973-805-0509
Mailing Address - Street 1:510 FALLS LN
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-0018
Mailing Address - Country:US
Mailing Address - Phone:973-805-0509
Mailing Address - Fax:
Practice Address - Street 1:510 FALLS LN
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-0018
Practice Address - Country:US
Practice Address - Phone:973-805-0509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty