Healthcare Provider Details

I. General information

NPI: 1407711021
Provider Name (Legal Business Name): RECHELLE L PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 KELLEYTOWN WOODS PKWY
MCDONOUGH GA
30252-3939
US

IV. Provider business mailing address

1091 OVERLOOK PKWY APT 234
MACON GA
31210-5900
US

V. Phone/Fax

Practice location:
  • Phone: 404-552-8898
  • Fax:
Mailing address:
  • Phone: 404-552-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015646
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: