Provider Demographics
NPI:1669680781
Name:PHIFER, JOHN DWAINE (LPC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DWAINE
Last Name:PHIFER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 JOHNSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NC
Mailing Address - Zip Code:27013-9480
Mailing Address - Country:US
Mailing Address - Phone:704-278-4622
Mailing Address - Fax:
Practice Address - Street 1:312 JOHNSTONE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013-9480
Practice Address - Country:US
Practice Address - Phone:704-278-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health