Provider Demographics
NPI:1841857026
Name:PHILLIPS, TIM A (PHD, ALA, EDS, MS)
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHD, ALA, EDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 MISS ANNIES DR SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3023
Mailing Address - Country:US
Mailing Address - Phone:256-624-7099
Mailing Address - Fax:
Practice Address - Street 1:108 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4216
Practice Address - Country:US
Practice Address - Phone:256-624-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2864A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor