Provider Demographics
NPI:1982733184
Name:PHILLIPS, KAY W (PHD, LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:W
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2101
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29484-2101
Mailing Address - Country:US
Mailing Address - Phone:843-875-1551
Mailing Address - Fax:843-376-0152
Practice Address - Street 1:303 E RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6336
Practice Address - Country:US
Practice Address - Phone:843-875-1551
Practice Address - Fax:843-376-0152
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0058601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical