MEDICARE: ADRYANE PHILLIPS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	004970	GA

General Provider Information

NPI Number	:	1972828176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRYANE PHILLIPS LPC

Provider Business Mailing Address
First Line	:	1087 REDAN TRAIL CT
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2542
Country	:	US
Telephone Number	:	770-378-8106
Fax Number	:	404-745-8485

Provider Business Practice Location Address
First Line	:	1919 JOHN WESLEY AVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30337-3605
Country	:	US
Telephone Number	:	404-762-9190
Fax Number	:	404-762-9101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	11/01/2024

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