Healthcare Provider Details

I. General information

NPI: 1780361022
Provider Name (Legal Business Name): JESSIE PHILLIPS LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HENDERSONVILLE RD STE 202
ASHEVILLE NC
28803-3245
US

IV. Provider business mailing address

204 LONGLEAF DR UNIT 201
ARDEN NC
28704-1330
US

V. Phone/Fax

Practice location:
  • Phone: 828-333-9320
  • Fax:
Mailing address:
  • Phone: 864-979-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6373
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: