Healthcare Provider Details

I. General information

NPI: 1285080051
Provider Name (Legal Business Name): CHASITY PHILLIPS MA,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W BANKHEAD HWY STE 100
VILLA RICA GA
30180-1737
US

IV. Provider business mailing address

514 W BANKHEAD HWY STE 100
VILLA RICA GA
30180-1737
US

V. Phone/Fax

Practice location:
  • Phone: 678-941-3868
  • Fax: 678-941-3217
Mailing address:
  • Phone: 678-941-3868
  • Fax: 678-941-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA10881
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: