Provider Demographics
NPI:1700152600
Name:PHILLIPS, ROBERT WESLEY (LADAC-II, NCAC, SAP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WESLEY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LADAC-II, NCAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 COOPERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37180-8731
Mailing Address - Country:US
Mailing Address - Phone:931-205-8368
Mailing Address - Fax:931-684-3370
Practice Address - Street 1:818 COOPERTOWN RD
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37180-8731
Practice Address - Country:US
Practice Address - Phone:931-205-8368
Practice Address - Fax:931-684-3370
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000001023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)