Provider Demographics
NPI:1740487941
Name:PHILLIPS, GAIL ALLISON (LCSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:ALLISON
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 PEACHTREE RD NW
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2153
Mailing Address - Country:US
Mailing Address - Phone:404-982-9010
Mailing Address - Fax:
Practice Address - Street 1:2964 PEACHTREE RD NW
Practice Address - Street 2:SUITE 510
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2153
Practice Address - Country:US
Practice Address - Phone:404-982-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0015281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical