Provider Demographics
NPI:1952056459
Name:PHILLIPS, THEANNAH REMI LOUISE (LICSW)
Entity type:Individual
Prefix:
First Name:THEANNAH
Middle Name:REMI LOUISE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:THEANNAH
Other - Middle Name:REMI LOUISE
Other - Last Name:DORRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1 HARRISON ST SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3102
Mailing Address - Country:US
Mailing Address - Phone:703-777-0100
Mailing Address - Fax:
Practice Address - Street 1:1 HARRISON ST SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3102
Practice Address - Country:US
Practice Address - Phone:703-777-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00945849104100000X
VA0903003190104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker