Healthcare Provider Details

I. General information

NPI: 1043792013
Provider Name (Legal Business Name): RACHEL CHRISTINE PHILLIPS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CAMINO DEL RIO S STE 307
SAN DIEGO CA
92108-3832
US

IV. Provider business mailing address

3110 CAMINO DEL RIO S STE 307
SAN DIEGO CA
92108-3832
US

V. Phone/Fax

Practice location:
  • Phone: 619-302-0832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118487
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: