Provider Demographics
NPI:1669587895
Name:PHILLIPS, DEB
Entity type:Individual
Prefix:
First Name:DEB
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:PO BOX 63314
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3454
Mailing Address - Country:US
Mailing Address - Phone:828-696-1234
Mailing Address - Fax:828-696-1257
Practice Address - Street 1:709 N JUSTICE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3454
Practice Address - Country:US
Practice Address - Phone:828-696-1234
Practice Address - Fax:828-696-1257
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003266Medicaid
NC2867874Medicare ID - Type Unspecified