Provider Demographics
NPI:1720253636
Name:PHILLIP, DEXTER (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DEXTER
Middle Name:
Last Name:PHILLIP
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11688 S LAUREL DR APT 3C
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3036
Mailing Address - Country:US
Mailing Address - Phone:301-213-8328
Mailing Address - Fax:
Practice Address - Street 1:VETERANS AFFAIRS MEDICAL CTR
Practice Address - Street 2:50 IRVING ST NW, CNRC - 2H200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500785211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical